Congratulations to the authors. Uchida and colleagues show that in the setting of acute type A aortic dissection mortality for both a limited strategy of replacing the ascending aorta or hemi-arch (AAR), and an extensive strategy of total arch repair (TAR) with classic or frozen elephant trunk, were only 7.1% and 6.0%, respectively; thus, even better than recently published results from peers quoting 10.4% and 11.3%, respectively.
Because TAR was associated with less-frequent late distal complications or events after years of follow-up, they concluded to recommend changing from an entry-oriented strategy to prolific use of TAR even instead of AAR to prevent those late distal events and thereby improving quality of life (QoL).