Aortic Hemiarch: A Viable Alternative for Older Adults Facing Aortic Dissection
NEW ORLEANS—February 1, 2026—In an intriguing revelation from the 2026 Society of Thoracic Surgeons Annual Meeting, it was found that ascending aortic hemiarch reconstruction provides the same long-lasting benefits for patients over 65 suffering from acute type A aortic dissection (ATAAD) as more intricate extended arch reconstruction methods. This conclusion stems from a detailed study examining the outcomes of 3,562 patients and their long-term survival as well as the need for further surgical interventions following the initial treatment for ATAAD.
The data analyzed came from the STS Adult Cardiac Surgery Database (ACSD), which includes nearly 8.5 million records of surgeries performed on adults and is linked to the Centers for Medicare & Medicaid Services database. Among the patients with ATAAD reviewed in this analysis, 74.2% underwent aortic hemiarch replacement while 25.8% received extended arch reconstruction at various hospitals across the United States from July 2017 to December 2023.
To clarify, aortic dissection occurs when there is a tear in the inner layer of the aorta, the body’s largest artery. This allows blood to flow between the layers of the aortic wall, effectively splitting them apart. Such a condition significantly raises the risk of aortic rupture, leading to life-threatening complications like interrupted blood flow to different body parts. Typically, emergency surgery is required for acute dissections affecting the ascending aorta, especially in individuals aged 65 and older. As John R. Spratt, MD, a clinical assistant professor of thoracic and cardiovascular surgery at University of Florida Health—a center renowned for its high volume of aortic surgeries—points out, cardiovascular surgeons have several techniques available for addressing these critical situations.
Ascending hemiarch replacement focuses on replacing the ascending portion of the aorta along with the underside of the first section of the aortic arch. This procedure generally presents lower risks and complexities compared to extended arch reconstruction. In contrast, extended arch reconstruction encompasses any operation that involves the replacement of the ascending aorta and either partial or complete replacement of the transverse arch, along with re-implantation of one or more vessels from the arch. Due to the need for longer durations of cardiopulmonary bypass, cardiac arrest, and advanced cerebral protection techniques, extended arch reconstructions often entail higher short-term operative risks compared to hemiarch replacements.
Spratt emphasized, "Patients who experience aortic dissection may require additional operations on the aorta later in life, even if their initial repair is successful. While extended arch reconstruction can potentially reduce the long-term risk of needing more open aortic surgeries, older patients face a shorter life expectancy, making it uncertain how much they would benefit from such procedures."
Upon reviewing six years of data, the study revealed that for patients aged over 65 undergoing surgery for acute dissection, extended arch reconstruction did not provide any significant long-term advantages in terms of survival rates or the likelihood of needing subsequent aortic surgeries, when compared with the hemiarch procedure.
"It’s crucial to weigh what the 'ideal' reconstruction might look like based on a CT scan against the individual risk profile of a patient. Our analysis suggests that most patients aged 65 and older who undergo repair for acute dissection will fare just as well with hemiarch reconstruction, achieving comparable long-term outcomes as they would with the more hazardous extended arch method," Spratt concluded.
The ACSD operates as part of the STS National Database, one of the most extensive and thorough clinical registries which tracks nearly 10 million cardiothoracic procedures conducted by over 4,300 surgeons. With data representing more than 95% of adult cardiac surgeries, the STS Database offers invaluable benchmarks for clinical outcomes in cardiothoracic surgery across the nation.
About The Society of Thoracic Surgeons
The Society of Thoracic Surgeons is a non-profit organization that represents over 8,000 surgeons, researchers, and allied health professionals globally, all dedicated to enhancing the outcomes for patients undergoing cardiothoracic surgical procedures.
