Hemi-Arch versus Total Arch Replacement in DeBakey Type I Communicating Acute Aortic Dissection

P0142 

Abstract Submission 

Masahiro Daimon (1), Yuki Asada (1), Takurou Makiura (1), Tatsuya Suzuki (1), Hiroaki Uchida (1), Junko Okamoto (1), Sachiko Kanki (1), Hideki Ozawa (1), Takahiro Katsumata (1)

(1) Osaka Medical and Pharmaceutical University, Osaka, Japan

Masahiro Daimon    -  Contact Me
Osaka Medical and Pharmaceutical University

Yuki Asada    -  Contact Me
Osaka Medical and Pharmaceutical University

Takurou Makiura    -  Contact Me
Osaka Medical and Pharmaceutical University

Tatsuya Suzuki    -  Contact Me
Osaka Medical and Pharmaceutical University

Hiroaki Uchida    -  Contact Me
Osaka Medical and Pharmaceutical University

Junko Okamoto    -  Contact Me
Osaka Medical and Pharmaceutical University

Sachiko Kanki    -  Contact Me
Osaka Medical and Pharmaceutical University

Hideki Ozawa    -  Contact Me
Osaka Medical and Pharmaceutical University

Takahiro Katsumata    -  Contact Me
Osaka Medical and Pharmaceutical University

Masahiro Daimon    -  Contact Me
N/A

Objective: Although recent reports indicate a trend towards a more extensive arch operation, the recommended extent of graft replacement in acute aortic dissection (AAD) is an ongoing controversy. Thus, this study compared early and late outcomes of hemi-arch versus total arch replacement for DeBakey type I communicating AAD.
Methods: From 2004 to 2022, 221 patients with AAD underwent emergent surgery at our institution. A total of 39 patients were excluded, including those with DeBakey type II AAD, non-communicating aortic dissection, chronic type B dissection, previous thoracic aortic surgery, and those who had undergone surgery more than 14 days after onset. The remaining 182 patients were included in this study. Eighty patients received hemi-arch and 102 received total arch replacement. We compared the early and late outcomes between the two procedures retrospectively.
Results: There were no significant differences in preoperative characteristics between the two procedures, except age. Patients over 80 years of age were more likely to have undergone hemi-arch replacement. No significant differences were observed in postoperative complications, and in-hospital mortality was statistically similar in both procedures (4/80 (5.0%) vs 3/102 (2.9%); p=.368). The mean follow-up period was 6.4 years (0-19.7 years). At 5 years, mortality was 15.0% after hemi-arch replacement and 8.5% after total arch replacement (p=.558). The cumulative incidence of aortic reoperation was 8.8% (11 reoperations in 7 patients) in the hemi-arch replacement and 9.8% (11 reoperations in 10 patients) in the total arch replacement (p=.443). Though both procedures required aortic reoperations, multiple reoperations were more likely in patients undergoing hemi-arch replacement (3cases vs 1case). In multivariate analysis, aortic reoperation was significantly common in patients under 60 years of age (OR, 2.85; 95% CI, 1.01-8.05) and in patients with residual entry in the distal aortic arch (OR, 3.40; 95% CI, 1.20-9.62).
Conclusion: While hemi-arch replacement is adequate to achieve the primary goal of saving the AAD patient, total arch replacement is also a feasible approach with similar results to hemi-arch replacement. Total arch replacement might be useful for patients with a younger age. The main limitation of this study was its retrospective approach to the analysis, thus selection bias of patients could not be eliminated.

Dissection