Abstract
Objective
Innumerable surgical techniques are currently deployed for repairing acute type A
aortic dissection (ATAAD). We analyzed our results using a conservative approach of
root-sparing and hemiarch techniques in higher-risk patients and root and total arch
replacement for lower-risk patients.
Methods
We queried our aortic database for consecutive patients who underwent ATAAD repair.
Patients who underwent conservative repair (group 1) were compared with those who
underwent extensive repair (group 2) using univariable and multivariable analysis.
Results
From 1997 to 2019, 343 patients underwent ATAAD repair. Two hundred forty had conservative
repair (root-sparing, hemiarch) whereas 103 had extensive repair (root replacement
and/or total arch). Group 1 was older with more comorbidities such as hypertension,
previous myocardial infarction, and renal dysfunction. Group 2 had more connective
tissue disease (2.1% vs 12.6%; P < .01), aortic insufficiency, and longer intraoperative times. The incidence of individual
postoperative complications was similar regardless of approach. A composite of major
adverse events (operative mortality, myocardial infarction, stroke, dialysis, or tracheostomy)
was higher in the conservative group (15.1% vs 5.9%; P = .03). Operative mortality was 5.6% and not different between groups. Ten-year survival
was similar with either surgical approach. Ten-year cumulative risk of reintervention
was greater in group 2 (5.6% vs 21% at 10 years; P < .01). In multivariable analysis, ejection fraction and diabetes were predictors
of major adverse events but not extensive approach. Extensive approach was a predictor
of late reoperation (odds ratio, 3.03 [95% confidence interval, 1.29-7.2]; P = .01).
Conclusions
A tailored conservative approach to ATAAD leads to favorable operative outcomes without
compromising durability.
Graphical abstract

Graphical Abstract
Key Words
Abbreviations and Acronyms:
AI (aortic insufficiency), ATAAD (acute type A aortic dissection), CI (confidence interval), CTD (connective tissue disease), CVG (composite valve graft), FET (frozen elephant trunk), IQR (interquartile range), MAE (major adverse events), MAPE (major adverse pulmonary events), OM (operative mortality), PND (permanent neurologic deficit), RCP (retrograde cerebral perfusion), SCI (spinal cord injury), TAR (total arch replacement), VSRR (valve-sparing root reimplantation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 11, 2021
Accepted:
December 1,
2020
Received in revised form:
November 16,
2020
Received:
May 28,
2020
Identification
Copyright
© 2021 by The American Association for Thoracic Surgery
ScienceDirect
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