The Impact of Sun's Procedure on Postoperative Aortic Remodeling in Patients with Retrograde and Classic Type A Aortic Dissections

Background: This study aims to compare the impact of Sun's procedure on distal aortic remodeling in patients with acute Stanford type A aortic dissection (TAAD), including retrograde TAAD (RTAAD) and classical TAAD. The procedure's role in promoting distal aortic remodeling is assessed, along with potential differences in outcomes between the two subtypes of type A aortic dissection. Methods: A total of 76 patients diagnosed with TAAD, including 31 with RTAAD and 45 with classical TAAD were enrolled between November 2019 and May 2023. Using Care- stream Image Suite V4, true and false lumen areas were retrospectively analyzed at five anatomical planes (pulmonary artery, abdominal trunk, superior mesenteric artery, left renal artery opening, and inferior mesenteric artery) preoperatively and three months postoperatively. Distal aortic remodeling outcomes were compared between the two groups. Results: Both the TAAD and retrograde type A aortic dissection (RTAAD) groups underwent Sun's procedure, consisting of total arch replacement, distal frozen elephant trunk technique, and ascending aorta replacement. In TAAD, the primary tear was excised through ascending aorta replacement, and stent expansion was used to enlarge the true lumen of the descending aorta. In RTAAD, stent grafts isolated the primary tear in the descending aorta and expanded the true lumen. No significant differences were observed between the groups in short-term distal aortic remodeling. There were no significant differences between the two groups in baseline characteristics, including sex, age, smoking history, hypertension, diabetes, coronary heart disease, and hyperlipidemia. Conclusions: These findings suggest that postoperative distal aortic remodeling may be influenced by factors beyond dissection type. Furthermore, Sun's procedure is an effective surgical approach for both TAAD and RTAAD patients.