Sutureless total arch replacement in patients with acute type A aortic dissection

Objective

Acute type A aortic dissection is a life-threatening condition characterized by high morbidity and mortality. Surgical intervention is the primary means of saving lives in acute type A aortic dissection cases; however, in-hospital mortality rates remain high. We implemented a novel surgical approach, the sutureless total arch replacement, aimed at reducing in-hospital mortality. This study compares the safety and efficacy of the sutureless total arch replacement with conventional total arch replacement.

Methods

The retrospective, single-center cohort study included 382 patients who underwent acute type A aortic dissection repair involving ascending aortic replacement, total arch replacement, and the frozen elephant trunk procedure at our institution between 2019 and 2023. Of these patients, 296 underwent conventional total arch replacement from 2019 to 2022, and 86 received sutureless total arch replacement from 2022 to 2023. Propensity score matching resulted in 77 patients each in the sutureless total arch replacement and conventional total arch replacement groups for comparison.

Results

The sutureless total arch replacement group had shorter total operative time, cardiopulmonary bypass time, circulatory arrest time, and reduced intraoperative bleeding (all P < .01). The sutureless total arch replacement group had significantly lower rates of in-hospital mortality (P < .05). There were no significant differences between the 2 groups in the incidence of postoperative complications, including the need for mechanical circulatory support, cerebrovascular events, and unplanned reoperation due to postoperative bleeding. After a minimum of 15 months of follow-up, there were no significant differences in mortality or reoperation rates among patients who survived the initial hospitalization (all P > .05).

Conclusions

Sutureless total arch replacement improves operative efficiency and bleeding control in acute type A aortic dissection repairs and is associated with lower in-hospital mortality.