Long-term results of various surgical treatments for type A acute aortic dissection

Objective. To study the long-term outcomes of various surgical treatments for acute type A aortic dissection in various hospitals. Material and methods. The study included 223 patients with acute type A aortic dissection who underwent surgery at the Petrovsky National Research Center of Surgery and the Polyakov Samara Regional Cardiology Dispensary between 2014 and 2023. Patients were divided into 3 groups: group 1 (114 patients) — frozen elephant trunk procedure at the Petrovsky National Research Center of Surgery; group 2 (90 patients) — ascending aortic replacement alone or with hemiarch procedure at the Polyakov Samara Regional Cardiology Dispensary; group 3 (19 patients) — classic elephant trunk procedure at the Polyakov Samara Regional Cardiology Dispensary. Long-term outcomes were assessed (mean follow-up period 53±24 months), and predictors of unsatisfactory outcomes were identified. Results. Eight-year survival rates were 87.6%, 69.5% and 71% (p1—2, 1—3<0.05), 7-year freedom from aortic-related mortality — 96.8%, 94.6% and 94.6% (p<0.05), 8-year freedom from aortic-related events — 92.0%, 55.5% and 87.5% (p1—2=0.004), respectively. Conclusion. Better 8-year survival and lower risk of reintervention in patients with acute type A aortic dissection were observed after frozen elephant trunk procedure. Risk factors of aortic complications after local proximal reconstructions for acute type A aortic dissection are dilation of proximal descending aorta >26 mm, dissection of supra-aortic vessels and abdominal aorta, false canal-to-aorta ratio >0.68 at the level of aortic isthmus and more than 3 secondary fenestrations >3 mm in thoracic aorta.