Ascending aortic arch reconstruction offers the same long-term benefits in patients over 65 years of age with type A acute aortic dissection (ATAAD) as more complex extensive arch repair procedures, according to a study presented today at the 2026 Society of Thoracic Surgeons Annual Meeting.
The finding came from a risk-adjusted analysis of 3,562 patients that looked at long-term survival and surgical reoperation for aortic disease after initial surgery for ATAAD. Patient data are drawn from the STS Adult Cardiac Surgery Database (ACSD), which contains nearly 8.5 million adult cardiac surgery records and is linked to the Centers for Medicare & Medicaid Services database. Of the ATAAD patients studied, 74.2% underwent aortic hemiarch replacement and 25.8% underwent extensive arch repair at a US hospital between July 2017 and December 2023.
Aortic dissection occurs when a tear in the inner lining of the aorta, the body’s largest blood vessel, allows blood to flow into the aortic wall and “dissect” the layers apart, which dramatically increases the risk of the aorta rupturing and cutting off blood flow to the affected parts of the body. Acute dissections affecting the ascending aorta usually require emergency surgery, often in patients aged 65 years and older. Cardiovascular surgeons have many options when planning surgery for these patients, said John R. Spratt, MD, clinical assistant professor of thoracic and cardiovascular surgery at University of Florida Health, a center with one of the highest volumes of aortic surgery in the country.
Ascending semiarch replacement involves replacement of the ascending aorta and the underside of the first segment of the aortic arch and is considered to have lower surgical risk and complexity compared to extensive arch repair. Extended arch reconstruction describes any procedure that includes replacement of the ascending aorta, partial or total replacement of the transverse arch, and reimplantation of one or more arch vessels. Depending on the technique used, most extensive arch reconstructions carry greater short-term operative risk due to the need for longer periods of cardiopulmonary bypass, cardiac arrest, and more advanced forms of brain protection required during the procedure compared to ascending hemiarch reconstruction.
Patients with aortic dissection may require additional aortic procedures later in life, even if the initial repair of the dissection was successful. Extensive arch repair may reduce the long-term risk of requiring additional open aortic surgery. However, older patients have a shorter overall life expectancy, and the extent to which they may derive these benefits is unclear.”
John R. Spratt, MD, Clinical Assistant Professor of Thoracic and Cardiovascular Surgery, University of Florida Health
In the six years of data reviewed in the study, extended arch reconstruction for acute dissection in patients older than 65 years offered no long-term advantage in terms of survival or rates of undergoing additional aortic surgery compared with the semiarch procedure.
“It is important to balance what the ‘ideal’ reconstruction may be when reviewing a CT scan with the overall risk profile of an individual patient. Based on our analysis, most patients 65 years of age and older who undergo acute dissection reconstruction will be fine with hemiarch reconstruction and have the same long-term results as they would with a higher-risk procedure,” Spratt said.
ACSD is part of the National STS Database, one of the largest and most comprehensive clinical registries with nearly 10 million cardiothoracic procedures performed by 4,300+ surgeons. With more than 95% of adult cardiac surgery procedures and the largest and most robust clinical thoracic surgery database in the US, data and outcomes from the STS database provide a true national benchmark for cardiothoracic surgery clinical outcomes.
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