Open surgery versus branched endovascular repair of the aortic arch in residual dissections after type A surgical repair - Report - MDSpire

Open surgery versus branched endovascular repair of the aortic arch in residual dissections after type A surgical repair

  • By

  • Giovanni Tinelli

  • Simona Sica

  • Nikolaos Tsilimparis

  • Maximilian Pichlmaier

  • Eugenio Neri

  • Aurélien Hostalrich

  • Tilo Kölbel

  • Jonathan Sobocinski

  • Marco Di Eusanio

  • Emanuele Gatta

  • Andres Schanzer

  • Guillaume Guimbretière

  • Diana Giannarelli

  • Ming Hao Guo

  • Yamume Tshomba

  • Massimo Massetti

  • Stéphan Haulon

  • International multicenter post-Dissection Arch Repair Study (DARS) Group

  • Daniel Becker

  • Giuseppe Panuccio

  • Bertrand Marcheix

  • Mario D’Oria

  • Mollynda McArthur

  • Paolo Beretta

  • Petroula Nana

  • Piergiorgio Bruno

  • Renata Kazue Nakahara Rocha

  • Sven Peterss

  • Thibaut Boisroux

  • Thomas Mesnard

  • Xavier Chaufour

  • February 17, 2026

  • 0 min

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Comparative Outcomes of Open Arch Surgery vs Branched Endovascular Repair Post-Type A Dissection

Overview

This multicentre retrospective study compared redo open arch repair (OAR) and arch branched endovascular aortic repair (a-BEVAR) in patients with residual aortic dissection after type A aortic dissection surgery. Both approaches showed similar 30-day mortality and stroke rates, but a-BEVAR was associated with fewer complications and shorter hospital stays.

Background

Acute Stanford type A aortic dissection (TAAD) requires emergency ascending aorta repair to prevent fatal complications. Despite initial surgery, 11.5–22.7% of patients develop residual arch and descending aorta dissections requiring further intervention. Redo open arch repair is complex and carries significant morbidity and mortality. Branched endovascular repair offers a less invasive alternative, but direct comparative data have been lacking.

Data Highlights

OutcomeOpen Arch Repair (n=57)a-BEVAR (n=57)P-value
30-day mortality3.5%5.3%0.220
Stroke rate5.3%3.5%0.650
Prolonged intubation (>48h)28.1%3.5%<0.001
Acute kidney injury31.6%8.8%0.002
Temporary dialysis22.8%7.0%0.002
Median hospital length of stay (days)2110<0.001
Mid-term mortality (median 30 months)10.5%12.3%0.770

Key Findings

  • 30-day mortality was low and comparable between OAR (3.5%) and a-BEVAR (5.3%).
  • Stroke rates did not differ significantly between groups (5.3% OAR vs 3.5% a-BEVAR).
  • OAR patients experienced significantly higher rates of prolonged intubation (>48 hours) compared to a-BEVAR (28.1% vs 3.5%).
  • Acute kidney injury and temporary dialysis were more frequent after OAR (31.6% and 22.8%) than a-BEVAR (8.8% and 7.0%).
  • Hospital length of stay was nearly doubled for OAR patients (median 21 days) versus a-BEVAR (median 10 days).
  • Mid-term mortality over a median 30-month follow-up was similar between groups (10.5% OAR vs 12.3% a-BEVAR).

Clinical Implications

a-BEVAR provides a less invasive alternative to redo open arch repair with reduced postoperative complications such as respiratory failure and renal injury. Shorter hospital stays with a-BEVAR may improve patient recovery and resource utilization. Patient selection should consider anatomical suitability and surgical risk to optimize outcomes.

Conclusion

In patients undergoing intervention for residual aortic dissection after type A repair, a-BEVAR offers comparable early mortality and stroke rates to open arch repair but with fewer complications and shorter hospitalization. Further long-term studies are warranted to confirm durability and survival benefits.

References

  1. Post-Dissection Arch Repair Study Group 2024 -- Comparative Outcomes of Open Aortic Arch Surgery and Branched Endovascular Repair for Residual Dissections Following Type A Surgical Intervention

Original Source(s)

Open surgery versus branched endovascular repair of the aortic arch in residual dissections after type A surgical repair

  • by Giovanni Tinelli, Simona Sica, Nikolaos Tsilimparis, Maximilian Pichlmaier, Eugenio Neri, Aurélien Hostalrich, Tilo Kölbel, Jonathan Sobocinski, Marco Di Eusanio, Emanuele Gatta, Andres Schanzer, Guillaume Guimbretière, Diana Giannarelli, Ming Hao Guo, Yamume Tshomba, Massimo Massetti, Stéphan Haulon, International multicenter post-Dissection Arch Repair Study (DARS) Group, Daniel Becker, Giuseppe Panuccio, Bertrand Marcheix, Mario D’Oria, Mollynda McArthur, Paolo Beretta, Petroula Nana, Piergiorgio Bruno, Renata Kazue Nakahara Rocha, Sven Peterss, Thibaut Boisroux, Thomas Mesnard, Xavier Chaufour

  • February 17, 2026

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