OBJECTIVE: The aim of this study was to evaluate the outcomes of different surgical strategies for acute Stanford type A aortic dissection (TAAD). SUMMARY BACKGROUND DATA: The optimal extent of aortic resection during surgery for acute TAAD is controversial. METHODS: This is a multicenter, retrospective cohort study of patients who underwent surgery for acute TAAD at 18 European hospitals. RESULTS: Out of 3902 consecutive patients, 689 (17.7%) died during the index hospitalization. Among 2855 patients who survived 3 months after surgery, 10-year observed survival was 65.3%, while country-adjusted, age-adjusted, and sex-adjusted expected survival was 81.3%, yielding a relative survival of 80.4%. Among 558 propensity score-matched pairs, total aortic arch replacement increased the risk of in-hospital (21.0% vs. 14.9%, P =0.008) and 10-year mortality (47.1% vs. 40.1%, P =0.001), without decreasing the incidence of distal aortic reoperation (10-year: 8.9% vs. 7.4%, P =0.690) compared with ascending aortic replacement. Among 933 propensity score-matched pairs, in-hospital mortality (18.5% vs. 18.0%, P =0.765), late mortality (at 10-year: 44.6% vs. 41.9%, P =0.824), and cumulative incidence of proximal aortic reoperation (at 10-year: 4.4% vs. 5.9%, P =0.190) after aortic root replacement was comparable to supracoronary aortic replacement. CONCLUSIONS: Replacement of the aortic root and aortic arch did not decrease the risk of aortic reoperation in patients with TAAD and should be performed only in the presence of local aortic injury or aneurysm. The relative survival of TAAD patients is poor and suggests that the causes underlying aortic dissection may also impact late mortality despite surgical repair of the dissected aorta.

Cardiac Surgery Molinette Hospital University of Turin Turin

Cardiothoracic Department University Hospital Udine

Cardiovascular Surgery Department University Hospital Gregorio Marañón Madrid Spain

Center for Global Health National Health Institute Rome Italy

Centre Hospitalier Annecy Genevois France

Department of Cardiac Surgery

Department of Cardiac Surgery 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Cardiac Surgery Centre Cardiologique du Nord de Saint Denis Paris

Department of Cardiac Surgery Glenfield Hospital Leicester

Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Surgery University Hospital Muenster Muenster

Department of Cardiovascular Surgery Hospital Clínic de Barcelona University of Barcelona Spain

Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta

Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon

Division of Cardiac Surgery Cardiothoracic and Vascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste

Division of Cardiac Surgery University of Verona Medical School Verona

German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich

Heart and Lung Center Helsinki University Hospital Helsinki

Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital Liverpool UK

LMU University Hospital Ludwig Maximilian University

Research Unit of Surgery Anesthesia and Critical Care University of Oulu Oulu Finland

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Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

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ClinicalTrials.gov
NCT04831073