Residual dissection in arch branch vessels following total arch replacement was associated with a lower likelihood of favorable recovery (OR 0.195; 95% CI 0.058-0.654; P<0.01).
Cohort (n=486)
Does residual dissection in arch branch vessels reduce the likelihood of favorable functional recovery in patients undergoing total arch replacement for type A aortic dissection?
Residual dissection in arch branch vessels following total arch replacement for type A aortic dissection is an independent predictor of poorer functional recovery.
Odds Ratio: 0.195 (95% CI 0.058–0.654)
Absolute Event Rate: 81.1% vs 95.3%
p-value: p=<0.01
Abstract Background Aortic dissection is a lethal condition requiring surgery for type A (TAAD) cases. While total arch replacement (TAR) removes the primary tear, residual dissection in arch branch vessels (RD-ABV) linked to fragile distal tissue or residual tears may perpetuate false lumen flow and subsequent complications. Methods This cohort study included patients undergoing total arch replacement for aortic dissection between January 2023 and December 2024. RD-ABV was assessed via postoperative imaging. Propensity score matching (PSM) was conducted at a ratio of 1:1 using age, gender and hypertension. The primary endpoint was a score of 0 - 2 on the modified Rankin scale (mRS). Secondary outcomes included a composite of all-cause mortality, reoperation, or cerebrovascular events. Multivariable logistic regression was used to evaluate associations between RD-ABV and outcomes. Results A total of 738 TAAD cases received TAR and 486 cases were finally included in this cohort study based on inclusion and exclusion criteria. Of these, 100 patients had RD-ABV, and 386 patients did not. After PSM, 97 patients were included in each group for further analysis. During the median (interquartile range) follow-up of 13.0 (5.0-19.0) months, 7.2% （7/97） and 11.3% （11/97）cases lost to follow up in RD-ABV group and control group, respectively. Favorable recovery was obtained in 81.1% of patients in the RD-ABV group vs. 95.3% in the control group. Multivariable logistic regression analysis revealed that RD-ABV was significantly associated with a lower likelihood of favorable recovery (OR = 0.195, 95% CI: 0.058–0.654, P 0.01). However, no significant difference was observed in the composite secondary outcome between the two groups. Conclusion RD-ABV independently predicts poorer functional recovery after aortic arch replacement, underscoring its clinical relevance as a modifiable risk factor for postoperative rehabilitation.
Yan et al. (Sat,) conducted a cohort in Type A aortic dissection (n=486). Residual dissection in arch branch vessels (RD-ABV) vs. No RD-ABV was evaluated on Score of 0 - 2 on the modified Rankin scale (mRS) indicating favorable recovery (OR 0.195, 95% CI 0.058-0.654, p=<0.01). Residual dissection in arch branch vessels following total arch replacement was associated with a lower likelihood of favorable recovery (OR 0.195; 95% CI 0.058-0.654; P<0.01).