ArticleThe Journal of thoracic and cardiovascular surgery2019
Late outcomes of strategic arch resection in acute type A aortic dissection.
Article in The Journal of thoracic and cardiovascular surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 3 of them syntheses that pooled it.
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Who cites it
40 citing papers in PubMed, 3 syntheses or guidelines pooled it, 73 citations in OpenAlex.
- Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis.General thoracic and cardiovascular surgery · 2022Pooled it
- Outcomes of hemi- vs. total arch replacement in acute type A aortic dissection: A systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2022Pooled it
- Hybrid repair versus conventional open repair for aortic arch dissection.The Cochrane database of systematic reviews · 2021Pooled it
- Article
- Impact of Intimal Tear Location on Clinical Outcomes in Extensive Arch Repair of Acute Stanford Type A Aortic Dissection.Journal of the American Heart Association · 2026Article
- Determining the aortic root diameter necessitating replacement during acute type A aortic dissection repair.JTCVS open · 2026Article
- Redo total arch replacement with frozen elephant trunk for patients with previous proximal aortic replacement for acute type A dissection.JTCVS open · 2026Article
- Limited versus extended arch replacement during acute type A aortic dissection repair for nonsyndromic patients with dissected arch vessels.JTCVS open · 2025Article
- Open ascending aorta replacement combined with fenestrated total aortic arch stenting.JTCVS techniques · 2025Article
- Malperfusion in Patients With Acute Type A Aortic Dissection: A Nationwide Analysis.The Annals of thoracic surgery · 2025Article
- Survival outcomes after surgery for type A aortic dissection: a contemporary Dutch nationwide registry study.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- The Interdisciplinary Aortic Team: Opportunities for Collaboration in Acute Aortic Syndromes.Seminars in interventional radiology · 2024Review
- Total Arch vs Hemiarch Repair in Acute Type A Aortic Dissection: Systematic Review and Meta-Analysis of Comparative Studies.CJC open · 2024Review
- Distal aortic progression following acute type A aortic dissection repair among patients with bicuspid and tricuspid aortic valves.The Journal of thoracic and cardiovascular surgery · 2024Article
- Reinterventions After Repair of Acute Type A Aortic Dissection: Incidence, Outcomes, and Risk Factors.The Annals of thoracic surgery · 2024Observational
- Outcomes of ascending aorta and partial arch replacement with entry resection for DeBakey type I acute aortic dissection.General thoracic and cardiovascular surgery · 2024Article
- The Clinical Impact of the Extension of Acute Type A Aortic Surgery on Long-Term Outcomes: Should We Tend to Be Conservative?Medicina (Kaunas, Lithuania) · 2023Observational
- Fate of descending aorta after acute type A aortic dissection repair.Journal of thoracic disease · 2023Article
- Total aortic arch replacement in acute type A aortic dissection - a single institutional experience.Indian journal of thoracic and cardiovascular surgery · 2023Article
- Differences among sexes in presentation and outcomes in acute type A aortic dissection repair.The Journal of thoracic and cardiovascular surgery · 2023Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo compare perioperative and long-term outcomes in patients undergoing hemiarch and aggressive arch replacement for acute type A aortic dissection (ATAAD).
methodsFrom 1996 to 2017, we compared outcomes of hemiarch (n = 322) versus aggressive arch replacements (zones 2 and 3 arch replacement with implantation of 2-4 arch branches, n = 150) in ATAAD. Indications for aggressive arch were arch aneurysm >4 cm or intimal tear in the aortic arch that was not resectable by hemiarch replacement, or dissection of arch branches with malperfusion.
resultsPatients in the aggressive arch group were significantly younger (mean age: 57 vs 61 years old) and had significantly longer hypothermic circulatory arrest, cardiopulmonary bypass, and aortic crossclamp times. There were no significant differences in perioperative outcomes between hemiarch and aggressive arch groups, including 30-day mortality (5.3% vs 7.3%, P = .38) and postoperative stroke rate (7% vs 7%, P = .96). Over 15 years, Kaplan-Meier survival was similar between hemiarch and aggressive arch groups (log-rank P = .55, 10-year survival 70% vs 72%). Given death as a competing factor, incidence rates of reoperation over 15 years (2.1% vs 2.0% per year, P = 1) and 10-year cumulative incidence of reoperation (14% vs 12%, P = .89) for arch and distal aorta pathology were similar between the 2 groups.
conclusionsBoth hemiarch and aggressive arch replacement are appropriate approaches for select patients with ATAAD. Aggressive arch replacement should be considered for an arch aneurysm >4 cm or an intimal tear at the arch unable to be resected by hemiarch replacement, or dissection of the arch branches with malperfusion.
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