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Total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Aggressive versus conservative
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  • Matti Jubouri,
  • Daniyal Ansari,
  • Feras Zaqout,
  • Mohamad Bashir,
  • Mohammed Idhrees
Matti Jubouri
Hull York Medical School

Corresponding Author:[email protected]

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Daniyal Ansari
St George's Hospital Medical School
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Feras Zaqout
Al Quds University
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Mohamad Bashir
NHS Wales Health Education and Improvement Wales
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Mohammed Idhrees
SRM Institutes for Medical Science Vadapalani
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Background: Acute type A aortic dissection (ATAAD) is a life-threatening medical condition requiring urgent surgical attention. It is estimated that 50% of ATAAD die within 24 hours of onset, with the mortality rate is increasing by 1-2% every additional hour without prompt intervention. A variety of ATAAD surgical repair techniques exist which has sparked controversy within the literature, with the main two strategies being proximal aortic replacement (PAR) and total arch replacement (TAR). Nevertheless, the question of which of these two strategies if the more optimal is still debatable. Aims: This commentary aims to discuss the recent study by Sa and colleagues which presents a pooled analysis of Kaplan-Meier-derived individual patient data from studies with follow-up comparing aggressive (TAR) and conservative (PAR) approaches to manage ATAAD patients. Methods: A comprehensive literature search was performed using multiple electronic databases including PubMed, Ovid, Google Scholar, EMBASE and Scopus in order to collate the relevant research evidence. Results: The more aggressive TAR approach for treating ATAAD seems to yield more favourable results including more optimal long-term survival as well as a lower need for reoperation. The frozen elephant trunk (FET) technique can be considered the mainstay TAR technique. Conclusion: It is valid to conclude that TAR with FET is the superior strategy for managing ATAAD patients.
22 Aug 2022Submitted to Journal of Cardiac Surgery
23 Aug 2022Submission Checks Completed
23 Aug 2022Assigned to Editor
23 Aug 2022Editorial Decision: Accept
Dec 2022Published in Journal of Cardiac Surgery volume 37 issue 12 on pages 4267-4268. 10.1111/jocs.16916