Distal Aortic Events following Emergent Aortic Repair for Acute DeBakey Type I Aortic Dissection: An Inverse Probability of Treatment Weighting Analysis.

Objective:  The goal of this study is to examine early and midterm results after surgical treatment of acute DeBakey type I aortic dissection (AIAD) and the effect of the range of aortic arch replacement on overall survival and prevention of distal aortic events.

Methods:  Between March 2002 and July 2020, a total of 374 AIAD aortic repairs were reviewed. A total of 154 (41.2%) patients had total arch replacement (TAR), whereas 220 (58.8%) had hemi- or partial arch replacement (PAR).

Results:  Operative mortality did not show a significant difference (7.7% in PAR, 13.0% in TAR, p = 0.096). Survival at 5 years showed no difference (77.8% in TAR, 72.6% in PAR, p = 0.14). Freedom from reoperations and reinterventions, as well as composite aortic events in the distal aorta, were comparable across groups (p = 0.21, 0.84, and 0.91, respectively). The inverse probability of treatment weighting-adjusted model displayed higher 5-year freedom from reoperations and aortic events in the TAR group (p = 0.029 and 0.054, respectively).

Conclusion:  The extent of arch replacement is determined based on the patient background, making it difficult to compare the superiority of both surgical methods. However, TAR for appropriately selected patients may provide the benefit of avoiding aortic events in the long term.