Validity of a Limited Ascending and Hemiarch Replacement for Acute Type A Aortic Dissection

Background The extent of arch repair at emergency surgery for acute type A dissection is controversial. This study was designed to evaluate the rationale of tear-oriented conservative ascending/hemiarch replacement, comparing it against total arch replacement. Methods A total of 134 consecutive patients with acute type A dissection who underwent emergency surgery between 1995 and 2005 were reviewed. Results The median age was 68 years (range, 19 to 90); the patients were 62 men and 72 women. The extent of aortic resection included the ascending aorta and hemiarch in 105 patients (group AH) and the total aortic arch in 29 patients (group TA). The hospital mortality rates in groups AH and TA were 6.7% and 6.9%, respectively. The actuarial survival rates were 77.4% (AH) and 80.8% (TA) after 5 years, and 63.5% (AH) and 80.8% (TA) after 10 years. The freedom rates from reoperation were 91.3% (AH) and 88.0% (TA) after 5 years, and 60.9% (AH) and 76.6% (TA) after 10 years. Multivariate analysis indicated that predictors of reoperation were Marfan syndrome and aortic valve regurgitation. Conclusions Limited ascending/hemiarch replacement did not increase the risk of reoperation and would not compromise late results.