Poon et al.[22 Poon SS, Theologou T, Harrington D, Kuduvalli M, Oo A, Field M. Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2016;5(3):156-73. doi:10.21037/acs.2016.05.06. https://doi.org/10.21037/acs.2016.05.06...
], 2016 |
2,221 patients from 14 studies |
Systemic review |
In-hospital mortality in hemiarch and TAR groups |
TAR group had longer cross-clamping bypass time |
Big variation in mortality rate in different studies |
High volume centres have good TAR results; if entry is in root and ascending aorta, then hemiarch is adequate |
Uehara et al.[2121 Uehara K, Matsuda H, Matsuo J, Inoue Y, Shijo T, Omura A, et al. Surgical outcomes of acute type A aortic dissection in patients undergoing cardiopulmonary resuscitation. J Thorac Cardiovasc Surg. 2021;161(4):1173-80. doi:10.1016/j.jtcvs.2019.11.135. https://doi.org/10.1016/j.jtcvs.2019.11....
], 2021 |
34 cases required CPR before surgery (out of a total of 519) |
Retrospective single-centre |
Aortic rupture was the most common cause of CPR (61.8%), followed by coronary malperfusion (13.5%) |
Preoperative neurological deficit, duration of CPR |
|
CPR duration > 15 minutes may be a contraindication for surgery |
Czerny et al.[2626 Czerny M, Schoenhoff F, Etz C, Englberger L, Khaladj N, Zierer A, et al. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA registry. J Am Coll Cardiol. 2015;65(24):2628-35. doi:10.1016/j.jacc.2015.04.030. https://doi.org/10.1016/j.jacc.2015.04.0...
], 2015 |
2,137 cases 717 had malperfusion) |
GERAADA analysis |
Cerebral malperfusion (6.8%), visceral malperfusion (3.8%) |
Peripheral malperfusion, coronary malperfusion, preoperative coma, tear in descending aorta, age |
Overall (16.9%), one-organ malperfusion (21.3%) |
Type of dissection and number of organs affected in malperfusion decide the outcome |
Yang et al.[2727 Yang B, Rosati CM, Norton EL, Kim KM, Khaja MS, Dasika N, Wu X, et al. Endovascular fenestration/stenting first followed by delayed open aortic repair for acute type A aortic dissection with malperfusion syndrome. Circulation. 2018;138(19):2091-103. doi:10.1161/CIRCULATIONAHA.118.036328. https://doi.org/10.1161/CIRCULATIONAHA.1...
], 2018 |
597 cases (137 treated with stent first and then index surgery approach) |
Retrospective single-centre |
Aortic rupture (4%) |
Multi-organ malperfusion, index surgery first approach |
First decade of follow-up (21%), second decade (10.7%) |
Risk of dying from MOF was 6.6 times higher compared to the aortic rupture; stable patient with malperfusion can be managed with stent first approach |
Dumfarth et al.[2929 Dumfarth J, Kofler M, Stastny L, Plaikner M, Krapf C, Semsroth S, et al. Stroke after emergent surgery for acute type A aortic dissection: predictors, outcome and neurological recovery. Eur J Cardiothorac Surg. 2018;53(5):1013-20. doi:10.1093/ejcts/ezx465. https://doi.org/10.1093/ejcts/ezx465...
], 2018 |
303 cases underwent TAAD repair |
Retrospective single-centre |
Overall stroke rate (15.8%), stroke in preoperative CPR cases (18.8%), no CPR cases (3.5%) |
Preoperative CPR, bovine arch, and malperfusion increase the incidence of stroke |
Overall (13.2%), patients with stroke (22.8%) |
Preoperative CPR and preoperative malperfusion syndromes are independent predictors of postoperative stroke |
Ikeno et al.[3232 Ikeno Y, Yokawa K, Yamanaka K, Inoue T, Tanaka H, Okada K, et al. The fate of aortic root and aortic regurgitation after supracoronary ascending aortic replacement for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2021;161(2):483-93.e1. doi:10.1016/j.jtcvs.2019.09.183. https://doi.org/10.1016/j.jtcvs.2019.09....
], 2021 |
339 cases underwent SCAR |
Retrospective single-centre |
At 5-year follow-up, aortic root-related redo surgery (2.5%), overall deaths (14.5%) |
Dilated SOV, number of commissural detachments |
13.6% |
SOV and commissural detachment are predictors of unfavorable outcomes |
Nishida et al.[3333 Nishida H, Tabata M, Fukui T, Takanashi S. Surgical strategy and outcome for aortic root in patients undergoing repair of acute type A aortic dissection. Ann Thorac Surg. 2016;101(4):1464-9. doi:10.1016/j.athoracsur.2015.10.007. https://doi.org/10.1016/j.athoracsur.201...
], 2016 |
316 cases underwent ARR during TAAD surgery |
Retrospective single-centre |
Aortic root event (11.6%) in the non-ARR group |
Dissection of > 2 SOV |
ARR group (12.5%), non-ARR group (4.7%) |
ARR reduces future aortic root events |
Conzelmann et al.[3737 Conzelmann LO, Weigang E, Mehlhorn U, Abugameh A, Hoffmann I, Blettner M, et al. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German registry for acute aortic dissection type A (GERAADA). Eur J Cardiothorac Surg. 2016;49(2):e44-52. doi:10.1093/ejcts/ezv356. https://doi.org/10.1093/ejcts/ezv356...
], 2015 |
2,137 TAAD cases treated with surgery |
Multi-centre, GERAADA data |
Mortality of TAAD surgery for septuagenarians (16%) and for octogenarians (35%) |
Age, preoperative coma, CPR, multi-organ malperfusion |
16.9% |
Mortality risk in TAAD patients depends on clinical presentation |
Nortan et al.[3939 Norton EL, Wu X, Farhat L, Kim KM, Patel HJ, Deeb GM, et al. Dissection of arch branches alone: an indication for aggressive arch management in type A dissection? Ann Thorac Surg. 2020;109(2):487-94. doi:10.1016/j.athoracsur.2019.06.060. https://doi.org/10.1016/j.athoracsur.201...
], 2020 |
399 cases underwent TAAD surgery, 190 had arch vessel dissection |
Retrospective single-centre |
Overall, there were no significant differences in major postoperative outcomes between hemiarch and zone 1/2/3 arch groups; 5-year survival: hemiarch (79%) vs. zone 1/2/3 cases (85%) |
Acute MI and cardiogenic shock, hemiarch group had higher reoperation rate at 5-year follow-up (23%) |
Hemiarch group (7%), zone 1/2/3 group (5%) |
Branch alone involvement without malperfusion should not be an indication of debranching |
Eusanio et al.[4141 Di Eusanio M, Berretta P, Cefarelli M, Jacopo A, Murana G, Castrovinci S, et al. Total arch replacement versus more conservative management in type A acute aortic dissection. Ann Thorac Surg. 2015;100(1):88-94. doi:10.1016/j.athoracsur.2015.02.041. https://doi.org/10.1016/j.athoracsur.201...
], 2014 |
240 cases (53 total arch replacements, 187 hemiarch) |
Retrospective single-centre |
5-year survival for arch and hemiarch group was 65% and 60%, respectively |
Distal entry tear, cardiogenic shock |
Arch group (22%), hemiarch group (24%) |
Aortic and patients’ characteristics greatly influenced the extent of the aortic replacement; 20% of the patients underwent arch replacement |
Yang et al.[4343 Yang B, Norton EL, Shih T, Farhat L, Wu X, Hornsby WE, et al. Late outcomes of strategic arch resection in acute type A aortic dissection. J Thorac Cardiovasc Surg. 2019;157(4):1313-21.e2. doi:10.1016/j.jtcvs.2018.10.139. https://doi.org/10.1016/j.jtcvs.2018.10....
], 2019 |
Hemiarch (322 cases), TAR (150 cases) |
Retrospective single-centre |
Stroke rate was the same in both groups (7% each), 10-year survival was similar (hemiarch 70% vs. TAR 72%) |
Arch > 4 cm, intimal tear in the arch, and branch malperfusion were indications for debranching |
Mortality was similar in both groups (hemiarch 5.3% vs. TAR 7.3%) |
Both hemiarch and TAR are appropriate in the selective cases |
Omura et al.[4444 Omura A, Miyahara S, Yamanaka K, Sakamoto T, Matsumori M, Okada K, et al. Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement. J Thorac Cardiovasc Surg. 2016;151(2):341-8. doi:10.1016/j.jtcvs.2015.03.068. https://doi.org/10.1016/j.jtcvs.2015.03....
], 2016 |
109 hemiarch cases and 88 TAR cases |
Retrospective single-centre |
5-year event rates were low in TAR group |
30% of TAR group cases had entry in the arch |
Hemiarch (14.7%), TAR (10.2%) |
Acceptable TAR mortality with good long-term survival; preoperative CPR and visceral malperfusion are bad indicators |
Preventza et al.[4646 Preventza O, Liao JL, Olive JK, Simpson K, Critsinelis AC, Price MD, et al. Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients. J Thorac Cardiovasc Surg. 2020;160(1):20-33.e4. doi:10.1016/j.jtcvs.2019.10.031. https://doi.org/10.1016/j.jtcvs.2019.10....
], 2020 |
3,154 following FET |
Meta-analysis |
SCI (4.7%), stroke (7.6%) |
Higher SCI rate in stent length > 15 cm or coverage of T8 vertebrae |
8.8% |
Unclear outcome, stent length < 10 cm was associated with less SCI |
Ma et al.[4848 Ma WG, Zhu JM, Zheng J, Liu YM, Ziganshin BA, Elefteriades JA, et al. Sun's procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation. Ann Cardiothorac Surg. 2013;2(5):642-8. doi:10.3978/j.issn.2225-319X.2013.09.03. https://doi.org/10.3978/j.issn.2225-319X...
] |
Sun’s procedure |
Retrospective single-centre |
Stroke (19.8%) |
SCI (2.5%) |
7.8% |
Higher mortality seen in patients with stroke, SCI, and low cardiac output |