Extensive Aortic Replacement Including Supra-aortic Extrathoracic Debranchement to Treat Aortic Dissection Favors Mid-term Survival on Cost of Increased Incidence of Non-fatal Cerebral Insults

Objectives: Acute aortic dissection comes with an increased risk for death or permanent disability. We recently propagated an optimized extension of surgery. Early, extensive surgical correction of the ascending and thoracic aorta in conjunction with extra-thoracic revascularization of supra-aortic branches might improve results.

Methods: Current treatment-strategies of aortic dissection focuses on complete ascendant aortic (AAR) and arch-replacement (AR), combined with frozen-elephant trunk procurement (FET) of the thoracic aorta and extra-thoracic debranchment of supra-aortic vessels (SAD) in deep hypo-thermic circulatory arrest. Between October 2015 and today, 35 patients underwent extensive surgery for aortic dissection or intra-mural hematoma of the ascending- or thoracic aorta. We compared results to our historic cohort (controls, N = 36).

Results: Complete AR with frozen FET and SAD was performed in 14 of 35 patients. Mean age was 62.6 years, 62.8% of patients were male. Compared with controls we observed a reduced in-hospital mortality (11% versus 19%). However, we observed a slightly increased incidence of non-fatal cerebral insults of the posterior cerebral artery (4/35). Surviving patients were discharged home via our collaborative rehabilitation center and are under surveillance in good clinical condition.

Comment: Extensive surgical treatment of acute aortic dissection results in favorable mid-term results. Modified flow patterns within the subclavian artery after extra-anatomic revascularization might favor posterior cerebral artery embolism. Surveillance data will analyze for impact of our strategy on long-term results.

No conflict of interest has been declared by the author(s).