IYSC06 - Repair of Acute type A aortic dissection with an aberrant right subclavian artery

Objectives: Acute type A aortic dissection (AAAD) in the presence of an aberrant right subclavian artery (ARSA) is very rare. There is still no consensus regarding the optimal management strategy. We retrospectively seek to evaluate safety and efficancy of total arch replacement (TAR) and frozen elephant trunk (FET) technique concomitant with bypass reconstruction . We retrospectively seek to evaluate the safety and efficacy of the different strategies in patients with ARSA.

Methods: We conducted a retrospective analysis of AAAD patients with ARSA who underwent total arch replacement (TAR) at West China Hospital between January 2018 and November 2024. Inclusion criteria included age ≥18 years, confirmed ARSA via contrast-enhanced CT, and no prior thoracic surgery. Patients with severe vascular disease, malignancies, or thoracic malformations were excluded. Surgical procedures were performed under moderate hypothermic circulatory arrest (HCA) with unilateral selective antegrade cerebral perfusion (SACP). ARSA was managed using either fenestration or reconstruction techniques. The primary endpoint was overall survival (OS), while secondary endpoints included postoperative complications and quality of life, assessed using the SF-36 questionnaire.

Results: Of 41 initially enrolled patients, 15 met the inclusion criteria, with 8 undergoing reconstruction and 7 undergoing fenestration (Table I). Operative times and cardiopulmonary bypass durations were similar between groups. Postoperative complications included pulmonary infection (3 fenestration, 2 reconstruction), ARSA occlusion (2 reconstruction), endoleak (1 reconstruction), and vocal cord injury (1 fenestration). One reconstruction patient required reoperation. Long-term follow-up revealed 1-year, 3-year, and 5-year survival rates of 79.0%, 70.2%, and 56.2%, respectively, with a 5-year mortality rate of 17.5% and reoperation rate of 11.8% (Fig 2). Quality of life was assessed using SF-36 questionnaire and the results showed there were no significant differences between the two groups in the eight domain including Physical Functioning (PF), Role-physical Functioning (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role-Emotional Functioning (RE) and Mental Health (MH) (Fig 3). Age and troponin were identified as the risk factors for a composite end point of all-cause death and aortic reoperation (Table II)

Conclusions: Both fenestration and reconstruction strategies demonstrated comparable outcomes in managing AAAD with ARSA, with similar survival rates, complication profiles, and quality of life results. These findings provide valuable insights for clinical decision-making in treating this complex condition, highlighting the efficacy of both approaches in improving patient outcomes.