All patients undergoing emergency surgery for AADA between 2010 and 2020 in our department (n = 370) were retrospectively reviewed in a single center non-randomized retrospective observational cohort study design. Patient with subacute or chronic aortic dissection were excluded from the database. Detailed inclusion and exclusion criteria applied for patient selection are listed in Table 1 . As a standard procedure for surgical treatment of AADA patients, all patients underwent replacement of the ascending aorta with distal anastomosis performed in circulatory arrest allowing an endoluminal inspection of the aortic arch to exclude entry sites at this region. Further extension of surgery toward the aortic root or the aortic arch was performed wherever relevant valvular pathology or extensive dissection, or tear was present at the level of the aortic root, or when an intimal tear was observed at the level of the aortic arch, respectively. A total of n = 120 patients with combined aortic root surgery and replacement of the proximal aortic arch without further treatment of the arch beyond the innominate artery and the supra-aortic vessels were identified and included. Surgery of the aortic root was defined as valve-sparing aortic root repair by the David procedure or root replacement by the Bentall procedure. Isolated use of surgical glue to realign the layers of the aortic wall was not considered as root surgery and not included. AADA patients who received concomitant AMDS implantation (n = 9, operated between August 2019 and December 2020) were compared to the remaining AADA patients without AMDS implantation (Control, n = 111, operated between January 2010 and October 2020). The excluded patients (n = 250) underwent a variety of different types of aortic surgery, including patients with isolated hemi-arch replacement without concomitant root surgery as well as total arch replacement. In patients with an intimal tear in the aortic arch, frozen elephant trunk procedure with a hybrid prosthesis was regularly performed.
Inclusion and exclusion criteria
| Inclusion criteria |
|---|
| Acute aortic dissection type A |
| Emergency surgery |
| Age > 18 years |
| Intraoperative dissection |
| Subacute or chronic aortic dissection |
| No aortic valve surgery |
| Surgery of the supra-aortic vessels |
| Anastomosis beyond aortic arch zone 0 |
| Isolated repair of the aortic wall by surgical glue |
Inclusion and exclusion criteria for patients participating in the study
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