Total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Aggressive versus conservative

Abstract

Background Acute type A aortic dissection (ATAAD) is a life‐threatening medical condition requiring urgent surgical attention. It is estimated that 50% of ATAAD die within 24 h of onset, with the mortality rate is increasing by 1%–2% every additional hour without prompt intervention. A variety of ATAAD surgical repair techniques exist which has sparked controversy within the literature, with the main two strategies being proximal aortic replacement (PAR) and total arch replacement (TAR). Nevertheless, the question of which of these two strategies if the more optimal is still debatable. Aims This commentary aims to discuss the recent study by Sa and colleagues which presents a pooled analysis of Kaplan–Meier‐derived individual patient data from studies with follow‐up comparing aggressive (TAR) and conservative (PAR) approaches to manage ATAAD patients. Methods A comprehensive literature search was performed using multiple electronic databases including PubMed, Ovid, Google Scholar, EMBASE, and Scopus to collate the relevant research evidence. Results The more aggressive TAR approach for treating ATAAD seems to yield more favorable results including more optimal long‐term survival as well as a lower need for reoperation. The frozen elephant trunk (FET) technique can be considered the mainstay TAR technique. Conclusion It is valid to conclude that TAR with FET is the superior strategy for managing ATAAD patients.

Experience with aortic arch inclusion technique using artificial blood vessel for type A aortic dissection: an application study

“…The surgical treatment of aortic dissection is to resect the most severely damaged aortic segment and prevent blood from entering the false lumen, including the original tear of the aorta and subsequent tear segments [8]. However, the most suitable surgical method for treating ATAAD remains a point of significant domestic and international debate [9][10][11]. Total ascending aortic arch replacement with the frozen elephant technique is the classic method for treating type A aortic dissection [12,13].…”

Experience with aortic arch inclusion technique using artificial blood vessel for type A aortic dissection: an application study

“…The surgical treatment of aortic dissection is to resect the most severely damaged aortic segment and prevent blood from entering the false lumen, including the original tear of the aorta and subsequent tear segments [8]. However, the most suitable surgical method for treating ATAAD remains a point of signi cant domestic and international debate [9][10][11]. Total ascending aortic arch replacement with elephant trunk stent technology is the classic method for treating type A aortic dissection [12,13].…”

Frozen elephant trunk: the gold standard

“…The primary aim of open surgical repair (OSR) in TAAD is resecting the origin of the intimal tear located in the ascending aorta. Importantly, this may extend to involve the arch and proximal descending thoracic aorta (DTA), hence necessitating partial or complete replacement of the aortic arch with possible ante-/retro-grade stenting of the DTA ( 1 ). Borst et al ( 2 ) were the first to describe the elephant trunk (ET) procedure which involves replacing varying portions of the ascending aorta and the arch with a separate free-floating stent extension inserted into the DTA.…”