Early and midterm outcomes of hemiarch replacement combined with stented elephant trunk in the management of acute DeBakey type I aortic dissection: comparison with total arch replacement.

OBJECTIVE: For patients with acute DeBakey type I aortic dissection without an intimal tear in the arch, the early and midterm outcomes of hemiarch replacement with stented elephant trunk were compared with those of total arch replacement.

METHODS: From January 2006 to December 2011, 197 patients with acute type I aortic dissection were identified without an intimal tear in the arch. Of the 197 patients, 71 underwent hemiarch replacement with stented elephant trunk implantation (hemiarch group) and 84 underwent ascending aorta and total arch replacement with stented elephant trunk implantation (total arch group).

RESULTS: The incidence of postoperative transient neurologic dysfunction, low cardiac output syndrome, and prolonged ventilation was lower in the hemiarch group (P<.05 for all). The hospital mortality was 4.2% and 5.9% for the hemiarch and total arch groups, respectively (P=.91). No difference was detected in survival between the 2 groups (P=.56). Complete thrombosis in the false lumen of the residual arch was found in 92.1% of those undergoing hemiarch replacement. The rate of complete thrombosis in the false lumen of the distal aorta was similar between the 2 groups (P>.05). The risk of an aortic event was similar for both groups (P=.62).

CONCLUSIONS: For patients with acute DeBakey type I dissection without an intimal tear in the arch, hemiarch replacement with stented elephant trunk implantation was easily performed, with satisfactory early and midterm outcomes. For these selective patients, total arch replacement with the stented elephant trunk technique did not improve the late surgical results further.