Outcomes of Hemiarch versus Zone 2 Arch Replacement for DeBakey I Aortic Dissection.
Publication/Presentation Date
1-12-2026
Abstract
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, ten-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 = 0.198). 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 compared 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.
ISSN
1873-734X
Published In/Presented At
Kelly, J. J., Gillinov, L. A., Zhao, Y., Sperry, A. E., Goel, N. J., Berezowski, M., Kapoor, S. R., Bavaria, J. E., Brown, C. R., Lawrence, K. M., Szeto, W. Y., & Desai, N. D. (2026). Outcomes of Hemiarch versus Zone 2 Arch Replacement for DeBakey I Aortic Dissection. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, ezag006. Advance online publication. https://doi.org/10.1093/ejcts/ezag006
Disciplines
Medicine and Health Sciences
PubMedID
41525355
Department(s)
Department of Surgery
Document Type
Article