Open surgery versus branched endovascular repair of the aortic arch in residual dissections after type A surgical repair - Scorecard - 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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Clinical Scorecard: Comparative Outcomes of Open Aortic Arch Surgery and Branched Endovascular Repair for Residual Dissections Following Type A Surgical Intervention

At a Glance

CategoryDetail
ConditionResidual aortic arch and descending thoracic aorta dissection after type A aortic dissection repair
Key MechanismsRedo open arch repair involves complex surgery with circulatory arrest and hypothermia; branched endovascular repair offers a less invasive alternative
Target PopulationPatients with residual chronic aortic arch and descending thoracic aorta dissection after previous open ascending aorta replacement for acute Stanford type A aortic dissection
Care SettingHigh-volume aortic surgery centers with multidisciplinary aortic teams

Key Highlights

  • 30-day mortality rates were similar between open arch repair (3.5%) and branched endovascular repair (5.3%)
  • Open arch repair was associated with higher rates of prolonged intubation, acute kidney injury, and temporary dialysis compared to branched endovascular repair
  • Branched endovascular repair resulted in significantly shorter hospital length of stay (median 10 days vs 21 days)

Guideline-Based Recommendations

Diagnosis

  • Use preoperative CT angiography to assess aortic anatomy and plan intervention
  • Indications for intervention include maximum aortic diameter >55 mm or rapid growth >10 mm/year

Management

  • Redo open arch repair remains standard but is associated with high morbidity
  • Arch branched endovascular aortic repair (a-BEVAR) is a less invasive alternative for patients at high surgical risk with suitable anatomy
  • Treatment strategy should be decided by a multidisciplinary aortic team based on patient comorbidity and anatomy

Monitoring & Follow-up

  • Postoperative CTA at 1 month, 6 months, and annually thereafter to monitor repair integrity and aortic status
  • Regular clinical follow-up to assess for complications such as stroke, kidney injury, and spinal cord ischemia

Risks

  • Open arch repair carries risks of prolonged intubation, acute kidney injury, temporary dialysis, and longer hospital stay
  • Both approaches carry risk of stroke and mortality, with no significant difference observed in mid-term follow-up

Patient & Prescribing Data

Patients with residual aortic arch and descending thoracic aorta dissection after prior type A aortic dissection repair

a-BEVAR is preferentially offered to patients at high surgical risk unfit for open surgery with suitable anatomy; both treatments show comparable mortality but differing complication profiles

Clinical Best Practices

  • Perform detailed preoperative imaging and multidisciplinary evaluation to select appropriate treatment modality
  • Consider a-BEVAR for patients with high surgical risk to reduce perioperative complications and hospital stay
  • Ensure adherence to device instructions for use during endovascular repair
  • Implement structured postoperative surveillance with CTA and clinical assessments to detect complications early
  • Recognize that long-term outcomes require further study to establish durability and survival benefits

References

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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