NEW ORLEANS—February 1, 2026—Ascending aortic hemiarch reconstruction offers the same long-term benefits to patients over age 65 with acute type A aortic dissection (ATAAD) as more complex extended arch reconstruction procedures, according to a study presented today at the 2026 Society of Thoracic Surgeons Annual Meeting.
The finding came from a risk-adjusted analysis of 3,562 patients examining long-term survival and surgical reintervention for aortic disease following initial operation for ATAAD. Patient data came from the STS Adult Cardiac Surgery Database (ACSD), containing nearly 8.5 million adult cardiac surgery procedure records and linked to the Centers for Medicare & Medicaid Services database. Of the ATAAD patients studied, 74.2% underwent aortic hemiarch replacement and 25.8% underwent extended arch reconstruction at a US hospital between July 2017 and December 2023.
Aortic dissection occurs when a tear in the inner lining of the aorta, the largest blood vessel in the body, allows blood to flow inside the aortic wall and "dissect" the layers apart, which dramatically increases the risk of aortic rupture and interruption of blood flow to the affected portions of the body. Acute dissections affecting the ascending aorta usually require emergency surgery, often in patients aged 65 or older. Cardiovascular surgeons have many options when planning surgery for these patients, said John R. Spratt, MD, clinical assistant professor of thoracic and cardiovascular surgery at University of Florida Health, a center with one of the highest aortic surgery volumes in the nation.
Ascending hemiarch replacement involves replacement of the ascending aorta and the underside of the first portion of the aortic arch and is considered to have lower operative risk and complexity compared with extended arch reconstruction. Extended arch reconstruction describes any procedure involving replacement of the ascending aorta, partial or total replacement of the transverse arch, and re-implantation of one or more arch vessels. Depending on the technique used, most extended arch reconstructions carry greater short-term operative risk due to the need for longer periods of cardiopulmonary bypass, cardiac arrest, and more advanced forms of cerebral protection that are needed during the procedure compared with ascending hemiarch reconstruction.
"Patients with aortic dissection can require additional aortic operations later in life, even if the initial dissection repair was successful," said Spratt. "Extended arch reconstruction may decrease the long-term risk of requiring additional open aortic surgery. However, older patients have a shorter overall life expectancy and the extent to which they can reap these benefits is unclear."
In the six years of data reviewed in the study, extended arch reconstruction for acute dissection in patients over the age of 65 did not confer any long-term advantage regarding survival or rates of undergoing additional aortic surgery compared to the hemiarch procedure.
"It is important to balance what the 'ideal' reconstruction may be when reviewing a CT scan with the overall risk profile of an individual patient. Based on our analysis, most patients age 65 and older undergoing repair of acute dissection will be fine with hemiarch reconstruction and have the same long-term outcomes as they would with a higher-risk procedure," said Spratt.
The ACSD is part of the STS National Database, one of the largest and most comprehensive clinical registries with nearly 10 million cardiothoracic procedures performed by 4,300+ surgeons. With more than 95% of adult cardiac surgery procedures and the largest and most robust clinical thoracic surgical database in the US, data and outcomes from the STS Database provide true national benchmarks for clinical outcomes of cardiothoracic surgery.
About The Society of Thoracic Surgeons
The Society of Thoracic Surgeons is a not-for-profit organization representing more than 8,000 surgeons, researchers, and allied healthcare professionals worldwide who are committed to improving outcomes for patients undergoing cardiothoracic surgery.
