New findings slated for presentation at the 2026 Society of Thoracic Surgeons (STS) Annual Meeting suggests that aortic hemiarch reconstruction provides outcomes comparable to more complex extended arch reconstruction in patients over age 65 with acute type A aortic dissection (ATAAD). John Spratt, MD, clinical assistant professor of thoracic and cardiovascular surgery at University of Florida Health, will present Extended Arch Reconstruction for Acute Type A Dissection Does Not Impact Long-Term Survival or Reoperation in Patients Over Age 65: An STS-CMS Longitudinal Analysis during Sunday’s 11:15 a.m. adult cardiac session, “Tips & Tricks to Get Through Any Dissection.”
The study used a risk-adjusted analysis of patients from the STS Adult Cardiac Surgery Database, which includes millions of adult cardiac surgery records. Patients underwent surgery at U.S. hospitals over several years, with most receiving aortic hemiarch reconstruction and the remainder undergoing extended arch reconstruction. Researchers evaluated postoperative mortality, stroke, and the need for reintervention for aortic disease and found no significant differences in these outcomes among patients ages 65 and older.
Extended arch reconstruction is a more complex operation that includes replacement of the aortic valve and repair of the ascending aorta, aortic arch, and the major arteries branching from the arch. Hemiarch reconstruction, by comparison, involves replacement of the aortic valve and repair of the ascending aorta and the underside of the aortic arch. Because aortic dissections most commonly affect older adults and require emergency surgery, surgeons must weigh the benefits of a more extensive repair against increased operative time, longer heart-lung bypass duration, and greater neurologic risk—factors that older patients often tolerate less well than younger individuals.
“You have to balance what a patient may need on paper, compared with what their overall risk profile is,” says Dr. Spratt. “The majority of patients age 65 and older will be fine with hemiarch reconstruction and have the same outcomes as they would with a higher-risk procedure.”