Aortic Hemiarch Matches Complex Arch in Older Adults

Ascending aortic hemiarch reconstruction offers similar long-term benefits as extended arch procedures for acute type A aortic dissection patients over 65

Feb. 1, 2026 at 9:55pm

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A study presented at the 2026 Society of Thoracic Surgeons Annual Meeting found that ascending aortic hemiarch reconstruction offers the same long-term benefits to patients over age 65 with acute type A aortic dissection as more complex extended arch reconstruction procedures. The analysis of 3,562 patients from the STS Adult Cardiac Surgery Database showed no significant differences in long-term survival or need for additional aortic surgery between the two surgical approaches.

Why it matters

Aortic dissection is a life-threatening condition that often requires emergency surgery, especially in older patients. Cardiovascular surgeons have several options when operating on these patients, with extended arch reconstruction considered a more complex procedure. This study suggests that the less invasive hemiarch replacement can provide similar long-term benefits for many older adults, potentially reducing surgical risk and recovery time.

The details

The study examined long-term outcomes for 3,562 patients who underwent surgery for acute type A aortic dissection at US hospitals between July 2017 and December 2023. Of these, 74.2% had ascending aortic hemiarch replacement and 25.8% had extended arch reconstruction. Hemiarch replacement involves replacing the ascending aorta and part of the aortic arch, while extended arch procedures also replace portions of the transverse arch and re-implant arch vessels. The researchers found no significant differences in long-term survival or rates of needing additional aortic surgery between the two surgical approaches.

  • The study analyzed data from July 2017 to December 2023.
  • The findings were presented at the 2026 Society of Thoracic Surgeons Annual Meeting.

The players

John R. Spratt, MD

Clinical assistant professor of thoracic and cardiovascular surgery at University of Florida Health, a center with one of the highest aortic surgery volumes in the nation.

STS Adult Cardiac Surgery Database (ACSD)

A clinical registry containing nearly 8.5 million adult cardiac surgery procedure records, which was linked to the Centers for Medicare & Medicaid Services database for this study.

The Society of Thoracic Surgeons

A not-for-profit organization representing more than 8,000 surgeons, researchers, and allied healthcare professionals worldwide who are committed to improving outcomes for patients undergoing cardiothoracic surgery.

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What they’re saying

“Patients with aortic dissection can require additional aortic operations later in life, even if the initial dissection repair was successful. Extended arch reconstruction may decrease the long-term risk of requiring additional open aortic surgery. However, older patients have a shorter overall life expectancy and the extent to which they can reap these benefits is unclear.”

— John R. Spratt, MD, Clinical assistant professor of thoracic and cardiovascular surgery (Mirage News)

“It is important to balance what the 'ideal' reconstruction may be when reviewing a CT scan with the overall risk profile of an individual patient. Based on our analysis, most patients age 65 and older undergoing repair of acute dissection will be fine with hemiarch reconstruction and have the same long-term outcomes as they would with a higher-risk procedure.”

— John R. Spratt, MD, Clinical assistant professor of thoracic and cardiovascular surgery (Mirage News)

The takeaway

This study suggests that the less invasive ascending aortic hemiarch reconstruction can provide similar long-term benefits as more complex extended arch procedures for many older adults with acute type A aortic dissection. This finding could help cardiovascular surgeons make more informed decisions about the appropriate surgical approach for these high-risk patients, potentially reducing operative risk and recovery time without compromising long-term outcomes.