B. Li et al. / Interactive CardioVascular and Thoracic Surgery
Author: Dimitrios Avgerinos Athens Medical Center, Athens, Greece doi: 10.1093/icvts/ivu370 © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Li et al. are to be congratulated for their thorough best evidence topic with the title "Is extended arch replacement justified for acute type A aortic dissection?" [1]. The authors claim that currently available evidence supports the use of total arch replacement in cases of type A dissection of the aorta, since there is no increased mortality with this more extended operation. The benefit from that operation, is the higher rates of false lumen thrombosis, compared with the hemiarch repair. From personal experience, I agree that more extensive arch surgery is imperative in cases where the intimal tear extends to the arch. It is crucial to include the tear to the aortic resection, in order to avoid future re-dissection with severe morbidity and
mortality. However, like everything else in cardiac surgery, the benefit should be weighted against the risk of the more extended operation. At our practice, we sometimes have to sacrifice a not-so-perfect operation of a total arch replacement for an operation of a lesser extent, especially in cases of older patients who would not tolerate an extended period of circulatory arrest. Also, in cases of prolonged malperfusion with end-organ damage, a more expedited operation may have better long-term outcome. However, in all the cases where a total arch is feasible and clinically logical, it should be the surgeon’s plan, in order to offer the patient the most sound operation with the least probability for future complications from the false lumen. Conflict of interest: none declared. Reference [1] Li B, Ma WG, Liu YM, Sun LZ. Is extended arch replacement justified for acute type A aortic dissection? Interact CardioVasc Thorac Surg 2015;20: 120–7.
BEST EVIDENCE TOPIC
eComment. Hemiarch or total arch replacement for type A aortic dissection?
127
Author: Dimitrios Avgerinos Athens Medical Center, Athens, Greece doi: 10.1093/icvts/ivu370 © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Li et al. are to be congratulated for their thorough best evidence topic with the title "Is extended arch replacement justified for acute type A aortic dissection?" [1]. The authors claim that currently available evidence supports the use of total arch replacement in cases of type A dissection of the aorta, since there is no increased mortality with this more extended operation. The benefit from that operation, is the higher rates of false lumen thrombosis, compared with the hemiarch repair. From personal experience, I agree that more extensive arch surgery is imperative in cases where the intimal tear extends to the arch. It is crucial to include the tear to the aortic resection, in order to avoid future re-dissection with severe morbidity and
mortality. However, like everything else in cardiac surgery, the benefit should be weighted against the risk of the more extended operation. At our practice, we sometimes have to sacrifice a not-so-perfect operation of a total arch replacement for an operation of a lesser extent, especially in cases of older patients who would not tolerate an extended period of circulatory arrest. Also, in cases of prolonged malperfusion with end-organ damage, a more expedited operation may have better long-term outcome. However, in all the cases where a total arch is feasible and clinically logical, it should be the surgeon’s plan, in order to offer the patient the most sound operation with the least probability for future complications from the false lumen. Conflict of interest: none declared. Reference [1] Li B, Ma WG, Liu YM, Sun LZ. Is extended arch replacement justified for acute type A aortic dissection? Interact CardioVasc Thorac Surg 2015;20: 120–7.
BEST EVIDENCE TOPIC
eComment. Hemiarch or total arch replacement for type A aortic dissection?
127
