Zone 2 Arch Repair for Acute Type A Dissection: Evolution From Arch-First to Proximal-First Repair

Authors

Suguru Ohira, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY.Follow
Vasiliki Gregory, New York Medical College, Valhalla, NY.
Joshua B. Goldberg, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY.Follow
Ramin Malekan, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY.Follow
Igor Laskowski, New York Medical College, Valhalla, NY.Follow
Corazon De La Pena, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY.
Steven L. Lansman, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY.Follow
David Spielvogel, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY.
Masashi Kai, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY.Follow

Author Type(s)

Student, Faculty

DOI

10.1016/j.xjtc.2023.06.012

Journal Title

JTCVS Techniques

First Page

7

Last Page

17

Document Type

Article

Publication Date

10-1-2023

Department

Surgery

Abstract

OBJECTIVE: With growing experience of acute type A aortic dissection repair, Zone 2 arch repair has been advocated. The aim of this study is to compare the outcome between "proximal-first" and "arch-first" Zone 2 repair. METHODS: From January 2015 to March 2023, 45 patients underwent Zone 2 arch repair out of 208 acute type A aortic dissection repairs: arch-first, N = 19, and proximal-first technique, N = 26, since January 2021. Indications were aortic arch or descending tear, complex dissection in neck vessels, cerebral malperfusion, or aneurysm of the aortic arch. RESULTS: The lowest bladder temperature was higher in the proximal-first technique (24.9 °C vs 19.7 °C, < .001). Cardiopulmonary bypass (230 vs 177.5 minutes, < .001), myocardial ischemic (124 vs 91 minutes, < .001), and lower-body circulatory arrest (87 vs 28 minutes, < .001) times were shorter in the proximal-first technique. The arch-first group required more packed red blood cells (arch-first, 2 units vs proximal-first, 0 units, = .048), platelets (arch-first, 4 units vs proximal-first, 2 units, = .003), and cryoprecipitates (arch-first, 2 units vs proximal-first, 1 unit, = .024). Operative mortality and major morbidities were higher in the arch-first group (57.9% vs 11.5%, = .001). One-year survival was comparable (arch-first, 89.5% ± 7.0% vs proximal-first, 92.0% ± 5.5%, = .739). Distal intervention was successfully performed in 5 patients (endovascular, N = 3, and open repair, N = 2). CONCLUSIONS: Zone 2 arch repair using the proximal-first technique for acute type A aortic dissection repair yields shorter lower-body ischemic time with a warmer core temperature, resulting in shorter cardiopulmonary bypass time, less blood product use, and fewer morbidities when compared with the arch-first technique.

Recommended Citation

Ohira, S., Gregory, V., Goldberg, J. B., Malekan, R., Laskowski, I., De La Pena, C., Lansman, S. L., Spielvogel, D., & Kai, M. (2023). Zone 2 Arch Repair for Acute Type A Dissection: Evolution From Arch-First to Proximal-First Repair. JTCVS Techniques, 21, 7-17. https://doi.org/10.1016/j.xjtc.2023.06.012