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Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection

 Joon Bum Kim  ;  Cheol Hyun Chung  ;  Jae Won Lee  ;  Suk Jung Choo  ;  Sung Ho Jung  ;  Taek Yeon Lee  ;  Geong Jun Ha  ;  Duk Hwan Moon 
 European Journal of Cardio-Thoracic Surgery, Vol.40(4) : 881-887, 2011 
Journal Title
 European Journal of Cardio-Thoracic Surgery 
Issue Date
OBJECTIVE: In acute DeBakey type I aortic dissection, it is still controversial whether to perform extended aortic replacement to improve long-term outcome or to use a conservative strategy with ascending aortic and hemiarch replacement to palliate a life-threatening condition. METHODS: Between 1999 and 2009, 188 consecutive patients (93 women; mean age, 57.4±11.7 years) with acute DeBakey type I aortic dissection underwent hemiarch (Hemiarch group; n=144) or total arch replacement (Total arch group; n=44) in conjunction with ascending aorta replacement. Clinical outcomes were compared after adjustment for baseline characteristics using inverse-probability-of-treatment weighting. RESULTS: Median follow-up was 47.5 months (range 0-130.4 months) and was 92.0% (n=173) complete. Five-year unadjusted survival and permanent-neurologic-injury-free survival rates were 65.8±8.3% and 43.1±9.7% in the Total arch group, and 83.2±3.3% and 75.2±4.0% in the Hemiarch group, respectively (P=0.013 and <0.001). After adjustment, the Total arch group patients were at greater risks of death (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.21-4.67; P=0.012), and permanent neurologic injury (HR 3.25, 95% CI 1.31-8.04; P=0.011) compared to the Hemiarch group patients. The risks of the re-operation for aortic pathology or distal aortic dilatation (>55 mm) were similar for both groups (HR 0.33, 95% CI 0.08-1.43; P=0.14). CONCLUSIONS: Total arch repair was associated with greater morbidity and mortality compared with hemiarch repair in acute DeBakey type I aortic dissection. Rates of aortic re-operation or aortic dilatation were not significantly different between the two surgical strategies. These findings support a conservative surgical approach to circumvent this life-threatening situation.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Thoracic & Cardiovascular Surgery (흉부외과학교실)
Yonsei Authors
이택연(Lee, Taek Yeon)
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