European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026
Outcomes of Hemiarch Versus Zone 2 Arch Replacement for DeBakey Type I Aortic Dissection.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Kelly John J, Gillinov Lauren A, Zhao Yu, Sperry Alexandra E, Goel Nicholas J, Berezowski Mikolaj, Kapoor Sankrit R, Bavaria Joseph E, Brown Chase R, Lawrence Kendall M, Szeto Wilson Y, Desai Nimesh D
Аннотация
OBJECTIVES: The objective of this study was to compare perioperative and long-term outcomes of hemiarch versus zone 2 arch replacement for DeBakey type I acute aortic dissection.
METHODS: From 2002 to 2023, 743 patients underwent surgical repair for DeBakey type I acute aortic dissection with either hemiarch (N = 605, 81.4%) or zone 2 arch replacement (N = 138, 18.6%). 4:1 propensity-score matching yielded a cohort of 437 hemiarch patients (76.1%) and 137 zone 2 patients (23.9%). Key outcomes included 30-day mortality, 10-year survival, and distal reintervention.
RESULTS: In the matched cohort, 30-day mortality was 11.9% for hemiarch and 8.0% for zone 2 arch replacement (P = .198). On multivariable analysis, zone 2 arch replacement was not associated with increased risk of 30-day mortality. Ten-year survival was similar between groups, at 56.2% (50.6%-62.6%) in the hemiarch group and 59.8% (46.4%-77.1%) in the zone 2 group. Distal reintervention was more common after zone 2 arch replacement (46.7% vs 15.8%), though the majority of reinterventions in the zone 2 group were thoracic endovascular aortic repair procedures (95.3%). In contrast, over half (53.6%) of distal reinterventions after hemiarch repair were open procedures.
CONCLUSIONS: Zone 2 arch replacement resulted in comparable early and late survival to hemiarch replacement. Although distal reinterventions were more common after zone 2 arch replacement, these were predominantly low-risk thoracic endovascular aortic repair procedures. In appropriately selected patients, zone 2 arch replacement may enable more complete aortic repair without added perioperative risk.
METHODS: From 2002 to 2023, 743 patients underwent surgical repair for DeBakey type I acute aortic dissection with either hemiarch (N = 605, 81.4%) or zone 2 arch replacement (N = 138, 18.6%). 4:1 propensity-score matching yielded a cohort of 437 hemiarch patients (76.1%) and 137 zone 2 patients (23.9%). Key outcomes included 30-day mortality, 10-year survival, and distal reintervention.
RESULTS: In the matched cohort, 30-day mortality was 11.9% for hemiarch and 8.0% for zone 2 arch replacement (P = .198). On multivariable analysis, zone 2 arch replacement was not associated with increased risk of 30-day mortality. Ten-year survival was similar between groups, at 56.2% (50.6%-62.6%) in the hemiarch group and 59.8% (46.4%-77.1%) in the zone 2 group. Distal reintervention was more common after zone 2 arch replacement (46.7% vs 15.8%), though the majority of reinterventions in the zone 2 group were thoracic endovascular aortic repair procedures (95.3%). In contrast, over half (53.6%) of distal reinterventions after hemiarch repair were open procedures.
CONCLUSIONS: Zone 2 arch replacement resulted in comparable early and late survival to hemiarch replacement. Although distal reinterventions were more common after zone 2 arch replacement, these were predominantly low-risk thoracic endovascular aortic repair procedures. In appropriately selected patients, zone 2 arch replacement may enable more complete aortic repair without added perioperative risk.