Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection: analysis of the German Registry for Acute Aortic Dissection Type A

J Thorac Cardiovasc Surg. 2012 Sep;144(3):617-23. doi: 10.1016/j.jtcvs.2011.07.066. Epub 2011 Nov 17.


Objective: Patients treated with an extensive approach including total aortic arch replacement for acute aortic dissection type A may have a favorable long-term prognosis by treating the residual false lumen. Our goal was to analyze the operative strategy for treatment of type I DeBakey aortic dissection from the German Registry for Acute Aortic Dissection Type A (GERAADA) data.

Methods: A total of 658 patients with type I DeBakey aortic dissection and entry only in the ascending aorta were identified in the GERAADA. Patients in group A underwent replacement of the ascending aorta with hemiarch replacement. Patients in group B received extensive treatment with total arch replacement or conventional or frozen elephant trunk.

Results: A total of 518 patients in group A and 140 patients in group B were treated. There was an overall 30-day mortality of 20.2% (n = 133). Group A had a slightly lower rate of mortality with 18.7% (n = 97) compared with 25.7% for group B (n = 36), but with no statistical significant difference (P = .067). The onset of new neurologic deficit (13.6% in group vs 12.5% in group B, P = .78) and new malperfusion deficit (8.4% in group A vs 10.7% in group B, P = .53) showed no statistical difference.

Conclusions: On analysis of the GERAADA data, it seems that a more aggressive approach of aortic arch treatment can be applied without higher perioperative risk even in the onset of acute aortic dissection type A. Long-term follow-up data analysis will be necessary to offer the optimal surgical strategy for different patient groups.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Aged
  • Aortic Aneurysm / mortality
  • Aortic Aneurysm / surgery*
  • Aortic Dissection / mortality
  • Aortic Dissection / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / methods*
  • Blood Vessel Prosthesis Implantation / mortality
  • Female
  • Germany
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Registries
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome