Total arch replacement in the treatment of acute type A aortic dissection

Abstract

The role of total arch replacement (TAR) in patients with acute type A aortic dissection (ATAD) has been much debated. There are numerous factors that contribute to the clinical decision-making process.These include patient cohort, clinical status of the patient, aortic anatomy, dissection morphology, and expertise of the surgeon and the center. In this review, we summarize early and late outcomes of TAR in ATAD patients and discuss the specific patient populations that may benefit from an aggressive surgical approach at the time of the initial acute presentation. We discuss techniques for TAR, differences in aortic remodeling, and long-term aortic prognosis of these patients.

Aortic Arch registry of type A aortic dissection (AoArch) - rationale, design and definition criteria

“…(19,20) Hybrid EAR with a frozen elephant trunk (FET) has become a popular and promising option for patients in need of aortic arch repair. (17,21,22) Single-center studies have indicated long-term benefits of this approach without increasing perioperative risks. The evidence supports the use of hybrid EAR as a diverse and effective alternative to traditional arch replacements.…”

“…(14)(15)(16)(17)(18) However, while technology has advanced, there are still concerns regarding the technical complexity, duration of cardiopulmonary bypass (CPB), and circulatory arrest. Furthermore, there is evidence of wide variability in outcomes from center to center, and a recent meta-analysis suggested that EAR approaches may be associated with increased perioperative mortality (13)(14)(15)(16)(17)(18)(22)(23)(24). It is important to acknowledge these issues and work towards finding solutions that benefit all parties involved.…”