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.