{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T02:48:14Z","timestamp":1775616494712,"version":"3.50.1"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T00:00:00Z","timestamp":1703376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Despite advances in surgical techniques, industry adjuncts, and cerebral perfusion techniques, the in-hospital mortality rate of type A acute dissection (TAAD) remains at 15\u201330%. This study aimed to investigate the influence of different extents of aortic resection on survival and quality of life (QoL) after long-term follow-up. Materials and Methods: A retrospective observational trial was performed, including 165 patients operated upon for TAAD. Patients were divided into two groups according to the extent of their aortic repair: the first group comprised patients who had ascending aorta replacement and the second included patients who had hemiarch or total arch replacement. The groups were compared with regard to their baseline characteristics, operative characteristics, survival, complications, and QoL during nine years of follow-up. Results: The mean follow-up time was 75.6 months (1\u2013108 months). The mean survival in the ascending aorta repair group was 89.651 (81.242\u201398.061) months and was 54.801 (40.053\u201369.548) months in the hemiarch and arch group; the difference between the groups was significant (log-rank p &lt; 0.001). The rate of new postoperative neurological deficits was statistically higher in the hemiarch and arch group (17.5% vs. 8.4%, p = 0.045), the most common being stroke, and was also more frequent in the hemiarch and arch group than in the ascending aorta group (with statistical significance (15.7% vs. 6.5%)). The mean SF-12 physical score from the QoL questionnaire was higher in the ascending aorta replacement group than in the hemiarch and arch group (50.1 \u00b1 7.3 vs. 44.0 \u00b1 11.9, p = 0.017). Additionally, the mean SF-12 mental score was higher in the ascending aorta replacement group (52.3 \u00b1 7.3 vs. 47.1 \u00b1 12.8, p = 0.032). Conclusions: A more aggressive approach involving aortic arch repair means a lower survival rate and lesser quality of life after long-term follow-up in comparison with the replacement of the ascending aorta. If clinically applicable, a more defensive strategy may be considered.<\/jats:p>","DOI":"10.3390\/medicina60010035","type":"journal-article","created":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T20:44:15Z","timestamp":1703450655000},"page":"35","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Clinical Impact of the Extension of Acute Type A Aortic Surgery on Long-Term Outcomes: Should We Tend to Be Conservative?"],"prefix":"10.3390","volume":"60","author":[{"given":"Natasa","family":"Jankovic","sequence":"first","affiliation":[{"name":"Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9558-0850","authenticated-orcid":false,"given":"Milos","family":"Matkovic","sequence":"additional","affiliation":[{"name":"Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8860-229X","authenticated-orcid":false,"given":"Ilija","family":"Bilbija","sequence":"additional","affiliation":[{"name":"Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladimir","family":"Milicevic","sequence":"additional","affiliation":[{"name":"Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina","family":"Zlatkovic","sequence":"additional","affiliation":[{"name":"Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nemanja","family":"Aleksic","sequence":"additional","affiliation":[{"name":"Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7868-7880","authenticated-orcid":false,"given":"Vladimir","family":"Cvetic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department for Cardiovascular Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4655-2383","authenticated-orcid":false,"given":"Jelena","family":"Milin-Lazovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Biostatistics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Svetozar","family":"Putnik","sequence":"additional","affiliation":[{"name":"Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jtcvs.2015.06.009","article-title":"Surgery for acute type A aortic dissection","volume":"150","author":"David","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"921","DOI":"10.21470\/1678-9741-2021-0178","article-title":"Aortic Root and Distal Arch Management During Type A Aortic Dissection Repair: Expanding Horizons","volume":"37","author":"Rathore","year":"2022","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"156","DOI":"10.21037\/acs.2016.05.06","article-title":"Hemiarch versus total aortic arch replacement in acute type A dissection: A systematic review and meta-analysis","volume":"5","author":"Poon","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1111\/jocs.15097","article-title":"Limited versus extended repair for type A aortic dissection involving the aortic arch","volume":"36","author":"Henn","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1016\/j.athoracsur.2018.03.088","article-title":"Extent of Aortic Replacement in Type A Dissection: Current Answers for an Endless Debate","volume":"106","author":"Waterford","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Chivasso, P., Mastrogiovanni, G., Miele, M., Bruno, V.D., Rosciano, A., Montella, A.P., Triggiani, D., Colombino, M., Cafarelli, F., and Leone, R. (2021). Frozen Elephant Trunk Technique in Acute Type A Aortic Dissection: Is It for All?. Medicina, 57.","DOI":"10.3390\/medicina57090894"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S197","DOI":"10.1016\/j.jtcvs.2012.11.068","article-title":"Simplified frozen elephant trunk repair for acute DeBakey type I dissection","volume":"145","author":"Roselli","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"346","DOI":"10.21037\/acs.2016.05.10","article-title":"IRAD experience on surgical type A acute dissection patients: Results and predictors of mortality","volume":"5","author":"Berretta","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.jtcvs.2019.11.084","article-title":"Commentary: Acute type A dissection-Should we systematically replace the aortic root?","volume":"161","author":"Bachet","year":"2021","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.5603\/KP.2014.0225","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases","volume":"72","author":"Erbel","year":"2014","journal-title":"Kardiol. Pol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1093\/ejcts\/ezx465","article-title":"Stroke after emergent surgery for acute type A aortic dissection: Predictors, outcome and neurological recovery","volume":"53","author":"Dumfarth","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1016\/S0140-6736(02)08594-X","article-title":"Survival plots of time-to-event outcomes in clinical trials: Good practice and pitfalls","volume":"359","author":"Pocock","year":"2002","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jss.2015.04.018","article-title":"Effects of a protocol-based management of type A aortic dissections","volume":"197","author":"Grau","year":"2015","journal-title":"J. Surg. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.jtcvs.2018.10.139","article-title":"Late outcomes of strategic arch resection in acute type A aortic dissection","volume":"157","author":"Yang","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1093\/ejcts\/ezx062","article-title":"Fate of the dissected aortic arch after ascending replacement in type A aortic dissectiondagger","volume":"51","author":"Rylski","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.athoracsur.2007.03.084","article-title":"Aortic enlargement and late reoperation after repair of acute type A aortic dissection","volume":"84","author":"Zierer","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"296","DOI":"10.21037\/acs.2016.06.01","article-title":"Surgical management and outcomes of type A dissection-the Mayo Clinic experience","volume":"5","author":"Cabasa","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1093\/ejcts\/ezx214","article-title":"Extended versus limited arch replacement in acute Type A aortic dissection","volume":"52","author":"Larsen","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_19","first-page":"175","article-title":"Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection\u2014Analysis of the German Registry for Acute Aortic Dissection type A (GERAADA)","volume":"2","author":"Easo","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/1753944718801568","article-title":"Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection","volume":"12","author":"Merkle","year":"2018","journal-title":"Ther. Adv. Cardiovasc. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.hlc.2016.02.004","article-title":"Predictors of Adverse Outcome and Transient Neurological Dysfunction Following Aortic Arch Replacement in 626 Consecutive Patients in China","volume":"26","author":"Liu","year":"2017","journal-title":"Heart Lung Circ."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.athoracsur.2015.08.073","article-title":"Aggressive Aortic Arch and Carotid Replacement Strategy for Type A Aortic Dissection Improves Neurologic Outcomes","volume":"101","author":"Trivedi","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/j.jtcvs.2015.11.056","article-title":"Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period","volume":"151","author":"Ma","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jtcvs.2019.10.031","article-title":"Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients","volume":"160","author":"Preventza","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"E102","DOI":"10.1532\/hsf.1738","article-title":"Quality of Life after Surgery for Stanford Type A Aortic Dissection: Influences of Different Operative Strategies","volume":"20","author":"Ghazy","year":"2017","journal-title":"Heart Surg. Forum"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/1\/35\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:41:26Z","timestamp":1760132486000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/1\/35"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,24]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["medicina60010035"],"URL":"https:\/\/doi.org\/10.3390\/medicina60010035","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,24]]}}}