Total aortic arch replacement in acute type A aortic dissection - a single institutional experience

Varun Shetty; Venkatesa Kumar Anakaputhur Rajan; Rohan Kiritkumar Makwana; Devi Prasad Shetty; Pradeep Narayan

doi:10.1007/s12055-023-01500-z

Total aortic arch replacement in acute type A aortic dissection - a single institutional experience

Indian J Thorac Cardiovasc Surg. 2023 Sep;39(5):489-496. doi: 10.1007/s12055-023-01500-z. Epub 2023 Mar 24.

Authors

Varun Shetty¹, Venkatesa Kumar Anakaputhur Rajan¹, Rohan Kiritkumar Makwana¹, Devi Prasad Shetty¹, Pradeep Narayan¹

Affiliation

¹ Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, India.

PMID: 37609625
PMCID: PMC10441847 (available on 2024-09-01)
DOI: 10.1007/s12055-023-01500-z

Abstract

Aim: Total arch replacement in the presence of acute aortic dissections is one of the most challenging areas of aortic surgery. Data on outcome in the Indian scenario is sparse. The aim of this study was to assess the outcome of arch replacements in a single tertiary care center.

Material and methods: In this single-center experience, 20 patients underwent total arch replacement between 2012 and 2022. Demographic, intraoperative, and postoperative data were abstracted from hospital records. Only patients with acute type A aortic dissection needing an arch repair were included. Patients with hemi-arch repairs, hybrid repairs, and those operated upon due to aneurysmal disease were excluded from the study. Comparison was made between survivors and non-survivors. Temporal trends for the procedure were assessed.

Results: The study included 20 patients who underwent total aortic arch replacement (TAR) during the study period (2012-2022). The mean age was 49.3 ± 12.5 years, and 15 (75%) of the patients were males. Seven (35%) patients were operated within 24 h of symptom onset. Permanent stroke was seen in 1 (5%) patient and temporary neurological dysfunction was observed in 1 (5%) patient. The re-exploration rate was 6 (30%) in the entire cohort and in-hospital mortality was 4 (20%). Follow-up was complete in 18 (90%) of the study population and 14 (87.5%) among survivors. There was one late death in our study which occurred after 46 months of the index operation. The overall mean survival was 76.1 months (95% CI: 49.86-102.43).

Conclusion: TAR can be performed both with acceptable mortality and morbidity in the presence of acute aortic dissections.

Keywords: Aortic aneurysm; Aortic resection; Thoracic aorta; Total aortic arch.

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