BACKGROUND: Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early outcome and durability of aortic surgery in these patients were investigated in the present study. METHODS: The subjects of the present analysis were patients under 60 years old who underwent surgical repair for acute DeBakey type 1 aortic dissection at 18 cardiac surgery centres across Europe between 2005 and 2021. Patients underwent ascending aortic repair or total aortic arch repair using the conventional technique or the frozen elephant trunk technique. The primary outcome was 5-year cumulative incidence of reoperation on the distal aorta. RESULTS: Overall, 915 patients underwent surgical ascending aortic repair and 284 patients underwent surgical total aortic arch repair. The frozen elephant trunk procedure was performed in 128 patients. Among 245 propensity score-matched pairs, total aortic arch repair did not decrease the rate of distal aortic reoperation compared to ascending aortic repair (5-year cumulative incidence, 6.7% versus 6.7%, subdistributional hazard ratio 1.127, 95% c.i. 0.523 to 2.427). Total aortic arch repair increased the incidence of postoperative stroke/global brain ischaemia (25.7% versus 18.4%, P = 0.050) and dialysis (19.6% versus 12.7%, P = 0.003). Five-year mortality was comparable after ascending aortic repair and total aortic arch repair (22.8% versus 27.3%, P = 0.172). CONCLUSIONS: In patients under 60 years old with DeBakey type 1 aortic dissection, total aortic arch replacement compared with ascending aortic repair did not reduce the incidence of distal aortic operations at 5 years. When feasible, ascending aortic repair for DeBakey type 1 aortic dissection is associated with satisfactory early and mid-term outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04831073.

Cardiac Surgery Molinette Hospital University of Turin Turin Italy

Cardiothoracic Department University Hospital Udine Italy

Cardiovascular Surgery Department University Hospital Gregorio Marañón Madrid Spain

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 France

Department of Cardiac Surgery Centre Hospitalier Annecy Genevois Epagny Metz Tessy France

Department of Cardiac Surgery Glenfield Hospital Leicester UK

Department of Cardiac Surgery Hôpitaux Universitaires Henri Mondor Assistance Publique Hôpitaux de Paris Creteil France

Department of Cardiac Surgery LMU University Hospital Ludwig Maximilian University Munich Germany

Department of Cardiac Surgery Martin Luther University Halle Wittenberg Halle Germany

Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany

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

Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon France

Division of Cardiac Surgery Cardio thoracic and Vascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste Italy

Division of Cardiac Surgery University of Verona Medical School Verona Italy

German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany

Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

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

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

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Tasoudis  PT, Magouliotis  DE, Varvoglis  DN, Ziogas  IA, Salmasi  MY, Spanos  K  et al.  Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis. Gen Thorac Cardiovasc Surg  2022;70:315–328 PubMed

Hsu  HL, Chen  YY, Huang  CY, Huang  JH, Chen  JS. The provisional extension to induce complete attachment (PETTICOAT) technique to promote distal aortic remodelling in repair of acute DeBakey type I aortic dissection: preliminary results. Eur J Cardiothorac Surg  2016;50:146–152 PubMed

Uehara  K, Matsuda  H, Matsuo  J, Inoue  Y, Omura  A, Seike  Y  et al.  Acute type A aortic dissection repair in younger patients. J Card Surg  2018;33:184–189 PubMed

Tamura  K, Chikazawa  G, Hiraoka  A, Totsugawa  T, Yoshitaka  H. Characteristics and surgical results of acute type A aortic dissection in patients younger than 50 years of age. Ann Vasc Dis  2019;12:507–513 PubMed PMC

Ma  WG, Chen  Y, Zhang  W, Li  Q, Li  JR, Zheng  J  et al.  Extended repair for acute type A aortic dissection: long-term outcomes of the frozen elephant trunk technique beyond 10 years. J Cardiovasc Surg  2020;61:292–300 PubMed

Piccardo  A, Regesta  T, Le Guyader  A, Di Lorenzo  N, Bertin  F, Pesteil  F  et al.  Outcomes after surgery for acute type A aortic dissection in “non-Marfan syndrome” patients with long life expectancy: a 24-year follow-up. Arch Cardiovasc Dis  2017;110:14–25 PubMed

Kimura  N, Tanaka  M, Kawahito  K, Itoh  S, Okamura  H, Yamaguchi  A  et al.  Early- and long-term outcomes after surgery for acute type A aortic dissection in patients aged 45 years and younger. Circ J  2011;75:2135–2143 PubMed

Biancari  F, Juvonen  T, Fiore  A, Perrotti  A, Hervé  A, Touma  J  et al.  Current outcome after surgery for type A aortic dissection. Ann Surg  2023;278:e885–e892 PubMed

Yan  Y, Xu  L, Zhang  H, Xu  ZY, Ding  XY, Wang  SW  et al.  Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: a meta-analysis. Eur J Cardiothorac Surg  2016;49:1392–1401 PubMed

Hsieh  WC, Kan  CD, Yu  HC, Aboud  A, Lindner  J, Henry  BM  et al.  Ascending aorta replacement vs. total aortic arch replacement in the treatment of acute type A dissection: a meta-analysis. Eur Rev Med Pharmacol Sci  2019;23:9590–9611 PubMed

Ma  L, Chai  T, Yang  X, Zhuang  X, Wu  Q, Chen  L  et al.  Outcomes of hemi- vs. total arch replacement in acute type A aortic dissection: a systematic review and meta-analysis. Front Cardiovasc Med  2022;9:988619. PubMed PMC

Sun  L, Qi  R, Zhu  J, Liu  Y, Zheng  J. Total arch replacement combined with stented elephant trunk implantation: a new “standard” therapy for type A dissection involving repair of the aortic arch?  Circulation  2011;123:971–978 PubMed

Zhang  H, Lang  X, Lu  F, Song  Z, Wang  J, Han  L  et al.  Acute type A dissection without intimal tear in arch: proximal or extensive repair?  J Thorac Cardiovasc Surg  2014;147:1251–1255 PubMed

Kim  JB, Chung  CH, Moon  DH, Ha  GJ, Lee  TY, Jung  SH  et al.  Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection. Eur J Cardiothorac Surg  2011;40:881–887 PubMed

Benedetto  U, Dimagli  A, Kaura  A, Sinha  S, Mariscalco  G, Krasopoulos  G  et al.  Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit. Eur Heart J  2021;43:44–52 PubMed PMC

Isselbacher  EM, Preventza  O, Hamilton Black  J  III, Augoustides  JG, Beck  AW, Bolen  MA  et al.  2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation  2022;146:e334–e482 PubMed PMC

Czerny  M, Schmidli  J, Adler  S, van den Berg  JC, Bertoglio  L, Carrel  T  et al.  Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg  2019;57:165–198 PubMed

Pan  E, Gudbjartsson  T, Ahlsson  A, Fuglsang  S, Geirsson  A, Hansson  EC  et al.  Low rate of reoperations after acute type A aortic dissection repair from the Nordic Consortium Registry. J Thorac Cardiovasc Surg  2018;156:939–948 PubMed

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ClinicalTrials.gov
NCT04831073