Repair strategy for acute type A aortic dissection in a regional center

Background The optimal extent of repair for DeBakey type I acute aortic dissection remains controversial, particularly in low- to medium-volume centers. We compared outcomes of ascending and arch replacement under a tear-oriented strategy in DeBakey type I dissection. Methods We retrospectively analyzed 114 consecutive patients with acute DeBakey type I dissection between April 2008 and July 2025 at a regional cardiovascular center. Ascending aortic replacement was performed in 55 patients, and arch replacement, including both partial and total arch replacement, in 59 patients. The primary endpoint was overall survival. Secondary endpoints included in-hospital mortality, major complications, and open aortic reoperation. Results Arch replacement required longer operative, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. In-hospital mortality was 5.5% after ascending aortic replacement and 13.6% after arch replacement ( P = 0.143). Rates of major complications were comparable between groups. Long-term survival was better after ascending aortic replacement than after arch replacement (5-year, 87.1% vs 69.4%; 10-year, 83.5% vs 59.8%; P = 0.015). Freedom from open aortic reoperation was similar between groups (5-year, 90.4% vs 88.3%; 10-year, 70.2% vs 88.3%; P = 0.201). In the subgroup analysis restricted to patients with an intimal tear in the aortic root or ascending aorta, there were no differences in the primary or secondary endpoints. Conclusions A tear-oriented limited replacement strategy appears reasonable in centers with limited volume of acute type A dissection repair.