Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection

Santi Trimarchi, Hector W.L. de Beaufort, Jip L. Tolenaar, Joseph E. Bavaria, Nimesh D. Desai, Marco Di Eusanio, Roberto Di Bartolomeo, Mark D. Peterson, Marek Ehrlich, Arturo Evangelista, Daniel G. Montgomery, Truls Myrmel, G. Chad Hughes, Jehangir J. Appoo, Carlo De Vincentiis, Tristan D. Yan, Christoph A. Nienaber, Eric M. Isselbacher, G. Michael Deeb, Thomas G. GleasonHimanshu J. Patel, Thoralf M. Sundt, Kim A. Eagle

Research output: Contribution to journalArticlepeer-review


Objective: To analyze presentation, management, and outcomes of acute aortic dissections with proximal entry tear in the arch. Methods: Patients enrolled in the International Registry of Acute Aortic Dissection and entry tear in the arch were classified into 2 groups: arch A (retrograde extension into the ascending aorta with or without antegrade extension) and arch B (only antegrade extension into the descending aorta or further distally). Presentation, management, and in-hospital outcomes of the 2 groups were compared. Results: The arch A (n = 228) and arch B (n = 140) groups were similar concerning the presence of any preoperative complication (68.4% vs 60.0%; P =.115), but the types of complication were different. Arch A presented more commonly with shock, neurologic complications, cardiac tamponade, and grade 3 or 4 aortic valve insufficiency and less frequently with refractory hypertension, visceral ischemia, extension of dissection, and aortic rupture. Management for both groups were open surgery (77.6% vs 18.6%; P <.001), endovascular treatment (3.5% vs 25.0%; P <.001), and medical management (16.2% vs 51.4%; P <.001). Overall in-hospital mortality was similar (16.7% vs 19.3%; P =.574), but mortality tended to be lower in the arch A group after open surgery (15.3% vs 30.8%; P =.090), and higher after endovascular (25.0% vs 14.3%; P =.597) or medical treatment (24.3% vs 13.9%; P =.191), although the differences were not significant. Conclusions: Acute aortic dissection patients with primary entry tear in the arch are currently managed by a patient-specific approach. In choosing the management type of these patients, it may be advisable to stratify them based on retrograde or only antegrade extension of the dissection.

Original languageEnglish
Pages (from-to)66-73
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number1
Publication statusPublished - Jan 2019


  • acute aortic syndrome
  • aortic dissection
  • aortic surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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