Hemiarch repair versus total-arch repair with frozen elephant trunk for acute type A aortic dissection: A propensity score-matched study.

Objective: The optimal extent of arch repair remains controversial in acute type A aortic dissection. Although hemiarch replacement (HAR) may offer more favorable perioperative outcomes, total arch replacement with frozen elephant trunk (TAR with FET) may offer superior long-term outcomes. This study aims to compare these strategies in a contemporary single-center cohort. Methods: Patients undergoing arch repair for acute type A aortic dissection between January 2020 and January 2025 were included. Propensity-score matching was used for further analyses. Primary outcomes included operative mortality and aortic reinterventions. Secondary outcomes included re-exploration for bleeding, renal failure, respiratory failure, neurologic complications, and aortic positive remodeling, defined as true lumen expansion greater than 50%. Results: Among 786 patients (171 hemiarch, 615 total arch), 272 patients were included in the matched cohort, comprising 136 matched pairs of HAR and TAR with FET, with a median follow-up of 3 years. Perioperative outcomes were comparable: operative mortality (5.1% HAR vs 7.4% TAR with FET; odds ratio [OR], 1.50; Conclusions: HAR and TAR with FET were associated with similar perioperative outcomes and 3-year survival rate. Although aortic remodeling is superior in TAR with FET group, 3-year aortic reintervention rates were comparable. Our findings suggest that TAR may be considered more proactively in high-volume aortic centers; however, longer-term clinical benefits remain undefined. Further study is warranted.