Is Hemiarch Replacement Adequate in Acute Type A Aortic Dissection Repair in Patients with Arch Branch Vessel Dissection Without Cerebral Malperfusion

ABSTRACT Objective To determine if hemiarch replacement is an adequate arch management strategy for patients with acute type A aortic dissection (ATAAD) and arch branch vessel dissection (ABVD) but no cerebral malperfusion. Methods From 2008-August 2019, 479 patients underwent open ATAAD repair. After excluding those with aggressive arch replacement (n=168), cerebral malperfusion syndrome (n=34), and indeterminable ABVD (n=1), 276 patients with an ATAAD without cerebral malperfusion syndrome who underwent hemiarch replacement comprised this study. Patients were then divided based on ABVD(n=133) vs. no-ABVD(n=143). Results The median age of the entire cohort was 62-years-old, with the ABVD group being younger (60 vs 62 years, p=0.048). Both groups had similar aortic arch and descending thoracic aortic diameters with significantly more DeBakey type I dissections (100% vs. 80%) in the ABVD group. The ABVD group had more aortic root replacement (36% vs 27%, p=0.0035) and longer aortic cross-clamp times (153 vs 128 minutes, p=0.007). Postoperative outcomes were similar between ABVD and no-ABVD groups, including stroke (10% vs 5%, p=0.12) and operative morality (7% vs 5%, p=0.51). The ABVD group had a significantly greater cumulative incidence of reoperation (8-year: 19% vs 4%, p=0.04) with a hazard ratio of 2.89 (95% CI: [1.01, 8.27] p=0.048), which was similar between groups amongst only DeBakey type I dissections (8-year: 19% vs 5%, p=0.11). The 8-year survival was similar between ABVD and no-ABVD groups (76% vs 74%, p=0.30). Conclusions Hemiarch replacement was adequate for ATAAD patients with ABVD without cerebral MPS, but carried a higher risk of late reoperation.