Abstract

Significant controversy exists in the management of type A aortic dissections with aortic arch involvement. There is a substantial variability in approaches to this complex problem ranging from simply replacing the ascending aorta to total arch replacement with frozen elephant trunk -- all of which balance the competing interests of reducing operative risk and reducing risk of reintervention. The diversity of clinical details, variability of surgical experience, and lack of significant randomized data make a consensus approach to these patients unlikely. However, it is important to understand the risks and benefits of each technique, and herein we evaluate the outcomes of each. Our approach to these patients has been to reserve arch replacement for those who have arch aneurysmal disease, imminent risk of rupture, or cerebral malperfusion, and perform a hemiarch replacement in all other scenarios with arch involvement. Such approach is easily taught, safe, and reproducible while focusing more on survival rather than long-term freedom from reintervention.