Zone 2 arch repair for acute type A dissection: Evolution from arch-first to proximal-first repair

ObjectiveWith growing experience of acute type A aortic dissection repair, Zone 2 arch repair has been advocated. The aim this study is to compare the outcome between “proximal-first” and “arch-first” repair.MethodsFrom January 2015 March 2023, 45 patients underwent out 208 repairs: arch-first, N = 19, proximal-first technique, 26, since 2021. Indications were or descending tear, complex in neck vessels, cerebral malperfusion, aneurysm arch.ResultsThe lowest bladder temperature was higher technique (24.9 °C vs 19.7 °C, P < .001). Cardiopulmonary bypass (230 177.5 minutes, .001), myocardial ischemic (124 91 lower-body circulatory arrest (87 28 .001) times shorter technique. arch-first group required more packed red blood cells (arch-first, units proximal-first, 0 units, .048), platelets 4 .003), cryoprecipitates 1 unit, .024). Operative mortality major morbidities (57.9% 11.5%, One-year survival comparable 89.5% ± 7.0% 92.0% 5.5%, .739). Distal intervention successfully performed 5 (endovascular, 3, open 2).ConclusionsZone using for yields time with a warmer core temperature, resulting cardiopulmonary time, less product use, fewer when compared