Long-Term Outcomes of Antegrade Thoracic Stent Grafting During Repair of Acute DeBakey I Dissection

This study evaluates the impact of antegrade stenting of the distal arch and proximal descending aorta in patients with acute type A aortic dissection (ATAAD) who underwent nontotal arch procedures. The analysis includes 733 nonsyndromic patients treated between 2005 and 2022, of whom 95 received antegrade stenting. A propensity-score analysis matched 95 pairs from each group.  The survival rates at 10 years were similar between the two groups. Additionally, the cumulative incidence of reintervention, accounting for the competing risk of death, was also similar between the two groups, with the nonstented group showing a 27 percent incidence of reintervention and the stented group showing 22 percent (P = 0.44).  The study suggests that antegrade thoracic endovascular aortic repair may not improve long-term survival or reduce the need for reintervention in acute type A aortic dissection. However, it may offer benefits for remodeling the aorta and facilitating future endovascular interventions, particularly in cases of malperfusion. Therefore, while the procedure does not appear to significantly affect survival or reintervention rates, it could still play a major role in the management and future treatment of these patients, particularly by reducing the need for later interventions related to malperfusion.