Treatment of acute aortic dissection with primary entries in the arch and extension to descending aorta

P0357 

Abstract Submission 

Jing Zhang (1), Wen-rui Ma (2), Xiaobin Zhang (1), Ye Kong (1), Jianfeng Zhang (1), dan zhu (3)

(1) Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, (2) Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China, SHANGHAI, NA, (3) Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, NA

Jing Zhang    -  Contact Me
Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine

Wen-rui Ma    -  Contact Me
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

Xiaobin Zhang    -  Contact Me
Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine

Ye Kong    -  Contact Me
Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine

Jianfeng Zhang    -  Contact Me
Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine

dan zhu    -  Contact Me
Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine

Jing Zhang    -  Contact Me
N/A

Objective: Acute aortic dissection with primary entries in the arch and extension to the distal descending aorta is infrequent and designated as type Arch B aortic dissection in the clinical situation. At present, the appropriate treatment of acute Arch B aortic dissection remains unclear. The aim of this study was to compare the outcomes of different treatments in patients with acute Arch B aortic dissection.
Methods: From 2001 to 2022, patients admitted emergently with a primary diagnosis of acute aortic dissection were screened, and a total of 57 candidates with Arch B aortic dissection were enrolled. The locations of the entries were determined by intraoperative inspection or angiography. Among these patients, 15 underwent total arch replacement (TAR) plus frozen elephant trunk, 14 underwent supra-arch debranching and retrograde stenting, and 28 underwent isolated endovascular intervention with fenestration or chimney technique. Baseline demographics, clinical outcomes including mortality and aortic reinterventions, and the computed tomography angiography-derived parameters of arch dimensions and remodeling, were compared across groups of different treatments. The median follow-up time was 55.5 months (interquartile range, 35-88 months).
Results: Overall mean age was 49.6 years (range, 26-80 years) with a male predominance (52/57, 91.2%). The in-hospital survival was comparable across 3 groups (14/15, 93.3% vs 13/14, 92.9% vs 28/28, 100%; log-rank P = 0.499), while there was a trend towards lower 5-year freedom from aortic reintervention in the TAR group (TAR vs non-TAR:100% vs 83.6% ± 6.8%, P = 0.057). At 5 years, the regressions of the arch and descending aorta were better in the TAR group than in non-TAR groups (aortic diameter at Zones 1-4: -1.2mm vs +0.01mm, P<0.001; -1.2mm vs +0.2mm, P<0.001; -1.6mm vs +0.14mm, P=0.001; and -0.6mm vs -0.10mm, P=0.121, respectively). The rate of complete descending aortic remodeling was also higher in the TAR group (66.7% vs 48.6%, P = 0.045).
Conclusions: In patients with acute Arch B aortic dissection, resection of the dissected arch may be beneficial with acceptable survival and superior freedom from aortic reintervention compared with non-resection treatments.

Aortic Arch