• Fausto Biancari, Tatu Juvonen, Antonio Fiore, Andrea Perrotti, Amélie Hervé, Joseph Touma, Matteo Pettinari, Sven Peterss, Joscha Buech, Angelo M Dell'Aquila, Konrad Wisniewski, Andreas Rukosujew, Till Demal, Lenard Conradi, Marek Pol, Petr Kacer, Francesco Onorati, Cecilia Rossetti, Igor Vendramin, Daniela Piani, Mauro Rinaldi, Luisa Ferrante, Eduard Quintana, Robert Pruna-Guillen, Rodriguez LegaJavierJCardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain., Angel G Pinto, Metesh Acharya, Zein El-Dean, Mark Field, Amer Harky, Francesco Nappi, Sebastien Gerelli, Di PernaDarioDCentre Hospitalier Annecy Genevois, France., Giuseppe Gatti, Enzo Mazzaro, Stefano Rosato, Peter Raivio, Mikko Jormalainen, and Giovanni Mariscalco.
• Heart and Lung Center, Helsinki University Hospital, Helsinki.
• Ann. Surg. 2023 Oct 1; 278 (4): e885e892e885-e892.

ObjectiveThe aim of this study was to evaluate the outcomes of different surgical strategies for acute Stanford type A aortic dissection (TAAD).Summary Background DataThe optimal extent of aortic resection during surgery for acute TAAD is controversial.MethodsThis is a multicenter, retrospective cohort study of patients who underwent surgery for acute TAAD at 18 European hospitals.ResultsOut of 3902 consecutive patients, 689 (17.7%) died during the index hospitalization. Among 2855 patients who survived 3 months after surgery, 10-year observed survival was 65.3%, while country-adjusted, age-adjusted, and sex-adjusted expected survival was 81.3%, yielding a relative survival of 80.4%. Among 558 propensity score-matched pairs, total aortic arch replacement increased the risk of in-hospital (21.0% vs. 14.9%, P =0.008) and 10-year mortality (47.1% vs. 40.1%, P =0.001), without decreasing the incidence of distal aortic reoperation (10-year: 8.9% vs. 7.4%, P =0.690) compared with ascending aortic replacement. Among 933 propensity score-matched pairs, in-hospital mortality (18.5% vs. 18.0%, P =0.765), late mortality (at 10-year: 44.6% vs. 41.9%, P =0.824), and cumulative incidence of proximal aortic reoperation (at 10-year: 4.4% vs. 5.9%, P =0.190) after aortic root replacement was comparable to supracoronary aortic replacement.ConclusionsReplacement of the aortic root and aortic arch did not decrease the risk of aortic reoperation in patients with TAAD and should be performed only in the presence of local aortic injury or aneurysm. The relative survival of TAAD patients is poor and suggests that the causes underlying aortic dissection may also impact late mortality despite surgical repair of the dissected aorta.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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