Impact of Residual Entry Tears in the Descending Aorta After Type A Dissection

The long-term benefits of total arch replacement (TAR) versus hemiarch replacement for treating aortic dissection have been debated, with most studies showing no difference in survival rates between the two methods. However, TAR may be more effective in preventing distal aortic events, particularly in patients under 70 years old. This study analyzed data to determine if age affects the benefits of TAR. The findings suggest that patients younger than 70-years-old benefit more from distal extended surgery to address primary entry tears in the descending aorta. In contrast, older patients (70 years and older) do not experience significant long-term benefits from TAR compared to hemiarch replacement. The study used a cutoff of 70 years based on receiver operating characteristic curve analysis. The German Registry for Acute Aortic Dissection Type A (GERAADA) supports these findings, noting more extensive dissection and organ malperfusion in younger patients. Although TAR with the frozen elephant trunk (FET) technique has shown promising results, especially in younger patients, the risks and benefits must be carefully weighed. The study concludes that aggressive TAR may be more beneficial for younger patients, while hemiarch replacement could suffice for older patients, even when the primary tear remains in the descending aorta.