Preliminary Results of the Non-Free Left Subclavian Artery and Single-Branch Stent Graft Technique in the Treatment of Acute DeBakey Type I Aortic Dissection

Background: This study aimed to explore the clinical advantages of the non-free left subclavian artery and single-branch stent graft technique in treating acute DeBakey Type I aortic dissection, with a focus on evaluating the impact of the technique on intraoperative efficiency, postoperative complications, and prognosis. Methods: This study retrospectively analyzed 58 patients with acute DeBakey type I aortic dissection admitted between August 2023 and October 2024. All enrolled patients underwent ascending aorta replacement in combination with total aortic arch replacement and descending aortic stent graft implantation. In the experimental group (n = 28), the left subclavian artery (LSA) was reconstructed using branched stent grafts for distal descending aortic repair, maintaining the anatomical integrity of the vessel and deliberately preserving the thoracic duct and recurrent laryngeal nerve. In the control group (n = 30), conventional minimally invasive stent reconstruction was employed for distal descending aortic repair with anatomical isolation of the LSA. Statistical analyses were conducted on intraoperative parameters (total operative time, heparinization duration), complications (chylothorax, hoarseness), and prognostic indicators (duration of tracheal intubation, mortality rate) using SPSS, version 26.0.0.0 (IBM Corp., Armonk, NY, USA), after controlling for preoperative baseline characteristics between groups. Results: The total surgical time in the experimental group was significantly shorter than that in the control group (256.21 ± 53.08 minutes vs. 298.97 ± 51.09 minutes; p = 0.003). The intensive care unit (ICU) length of stay (159.50 minutes vs. 257.00 minutes; p < 0.001) and postoperative hospital stay duration (14.00 days vs. 21.00 days; p = 0.001) were also shorter in the experimental group. There was no significant difference in mortality (28.57% vs. 10.00%; p = 0.071) and rethoracotomy rates (10.71% vs. 10.00%; p = 0.732) between the two groups. No cases of recurrent laryngeal nerve injury or chylothorax occurred in the experimental group, whereas the control group reported a 6.67% incidence of chylothorax and 10.00% noted hoarseness. Conclusion: The non-free left subclavian artery and single-branch stent graft technique can significantly shorten surgical time and reduce postoperative drainage volume and ICU stay duration. Additionally, no recurrent laryngeal nerve injury or chylothorax was observed in this group. Thus, this technique represents a safe and effective surgical approach for acute DeBakey Type I aortic dissection.