Aortic Remodeling After Stepwise External Wrapping for Type A Acute Aortic Dissection

BACKGROUND The optimal repair technique for type A acute aortic dissection is graft replacement; however, the treatment approach in high-risk patients remains controversial or suboptimal. METHODS We have retrospectively analyzed a cohort of high-risk patients who were admitted to our center for type A acute aortic dissection and who were treated by a new surgical approach using artificial grafts (stepwise external wrapping) between January 2016 and January 2020. The primary endpoints included inhospital mortality and survival during follow-up. Secondary endpoints included the assessment of aortic remodeling after ascending aorta wrapping. RESULTS Among the 134 patients admitted for type A acute aortic dissection, 43 patients underwent stepwise external wrapping. The mean patient age was 79.1 +/- 6.8 years. The new standard European System for Cardiac Operative Risk Evaluation score was 64% +/- 12%. There was one hospital death (2.3%). There were two major complications of persistent cerebral disorder (4.6%). Minor complications included temporary neurologic disorder (2.3%) and renal failure (2.3%). The intensive care unit and hospital stays were 2.8 +/- 1.0 days and 11.7 +/- 2.5 days, respectively. The follow-up survival rate was 95.3% +/- 6.2% and 91% +/- 10.2% at 1 and 3 years, respectively, after surgery. There was no aortic-related death during follow-up. At 1 year after surgery, complete remodeling of the ascending aorta was obtained in 30 patients (85.7%), and 5 patients (14.3%) showed partial remodeling. CONCLUSIONS Our stepwise external wrapping technique was associated with excellent outcomes for high-risk pa-tients with type A acute aortic dissection.(Ann Thorac Surg 2023;115:51-61)(c) 2023 by The Society of Thoracic Surgeons

Automated summary

A new surgical approach using artificial grafts (stepwise external wrapping) showed excellent outcomes for high-risk patients with type A acute aortic dissection, with low inhospital mortality and high survival rates during follow-up.