Total arch replacement versus proximal aortic replacement in acute type
A aortic dissection: Aggressive versus conservative
Abstract
Background: Acute type A aortic dissection (ATAAD) is a life-threatening
medical condition requiring urgent surgical attention. It is estimated
that 50% of ATAAD die within 24 hours of onset, with the mortality rate
is increasing by 1-2% every additional hour without prompt
intervention. A variety of ATAAD surgical repair techniques exist which
has sparked controversy within the literature, with the main two
strategies being proximal aortic replacement (PAR) and total arch
replacement (TAR). Nevertheless, the question of which of these two
strategies if the more optimal is still debatable. Aims: This commentary
aims to discuss the recent study by Sa and colleagues which presents a
pooled analysis of Kaplan-Meier-derived individual patient data from
studies with follow-up comparing aggressive (TAR) and conservative (PAR)
approaches to manage ATAAD patients. Methods: A comprehensive literature
search was performed using multiple electronic databases including
PubMed, Ovid, Google Scholar, EMBASE and Scopus in order to collate the
relevant research evidence. Results: The more aggressive TAR approach
for treating ATAAD seems to yield more favourable results including more
optimal long-term survival as well as a lower need for reoperation. The
frozen elephant trunk (FET) technique can be considered the mainstay TAR
technique. Conclusion: It is valid to conclude that TAR with FET is the
superior strategy for managing ATAAD patients.