Hemiarch vs Extended Arch in Type 1 Aortic Dissection

NCT ID: NCT03885635

Last Updated: 2025-09-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-07-30

Study Completion Date

2027-03-31

Brief Summary

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HEADSTART is a prospective, open-label, non-blinded, multicenter, randomized controlled trial that compares a composite of mortality and re-intervention in patients undergoing hemiarch and extended arch repair for acute DeBakey type 1 aortic dissection. Eligible patients will be randomized to one or the other surgical strategy and clinical and imaging outcome data will be collected over a 3 year follow up period.

Detailed Description

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DeBakey Type 1 aortic dissections continue to have high operative mortality and morbidity and there is equipoise in available literature with regards to the best operative strategy and patient selection criteria. Hemiarch repair is current standard of care in most centers but extended arch repair is gaining popularity aiming to address early post-operative malperfusion and improve long term aortic remodeling.

HEADSTART is a randomized controlled prospective trial of patients presenting to participating institutes with acute DeBakey 1 aortic dissection. Patients will be enrolled and randomized into one of two groups - 'hemiarch repair' and 'extended arch repair'. Pre-operative, early post-operative and long term follow clinical and CT imaging data will be collated on a centralized database and at a core lab respectively.

Conditions

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Aortic Dissection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Hemiarch vs. extended arch repair in the setting of acute DeBakey type 1 aortic dissections
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Hemiarch repair

Standard hemiarch repair with open distal anastomosis in the proximal arch without replacement of the head vessels.

Group Type ACTIVE_COMPARATOR

Hemiarch repair

Intervention Type PROCEDURE

Current standard of surgical repair consisting of ascending aortic replacement with open distal anastomosis at level of proximal arch under a period of hypothermic circulatory arrest . No surgical or endovascular intervention is carried out in the mid arch or descending aorta. Intra-operative management, including cannulation, cardioplegia, cerebral perfusion technique, and neurologic monitoring will be done according to each institution's current standard of practice.

Extended arch repair

Ascending aortic and arch replacement with or without head vessel re-implantation and single TEVAR device placement within 1 week.

Group Type ACTIVE_COMPARATOR

Extended arch repair

Intervention Type PROCEDURE

Surgical replacement of the ascending aorta along with intervention on the arch and descending aorta. Techniques for distal aspect of extended arch technique include but are not limited to total arch replacement along with TEVAR, Frozen Elephant Trunk procedure or surgical proximal arch replacement with bare metal stents in arch and descending aorta. Intra-operative management, including cannulation, cardioplegia, cerebral perfusion technique, and neurologic monitoring will be done according to each institution's current standard of practice.

Interventions

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Hemiarch repair

Current standard of surgical repair consisting of ascending aortic replacement with open distal anastomosis at level of proximal arch under a period of hypothermic circulatory arrest . No surgical or endovascular intervention is carried out in the mid arch or descending aorta. Intra-operative management, including cannulation, cardioplegia, cerebral perfusion technique, and neurologic monitoring will be done according to each institution's current standard of practice.

Intervention Type PROCEDURE

Extended arch repair

Surgical replacement of the ascending aorta along with intervention on the arch and descending aorta. Techniques for distal aspect of extended arch technique include but are not limited to total arch replacement along with TEVAR, Frozen Elephant Trunk procedure or surgical proximal arch replacement with bare metal stents in arch and descending aorta. Intra-operative management, including cannulation, cardioplegia, cerebral perfusion technique, and neurologic monitoring will be done according to each institution's current standard of practice.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Emergent surgical repair of Acute DeBakey Type 1 aortic dissection
2. Age \>18 years and \<70 years
3. Operating surgeon believes that both surgeries could be safe and effective

Exclusion Criteria

1. Hemodynamic instability/shock defined as systolic BP \< 90 mm Hg
2. Previous cardiac surgery with sternotomy or thoracic endograft placement
3. Aortic arch diameter \> 6cm in which a concomitant arch replacement is judged necessary
4. Procedures deemed to be "salvage operations" where the patient is unlikely to survive hospital discharge.
5. GCS \< 8 for more than 6 hours
6. History of cirrhosis.
7. History of chronic renal failure (baseline eGFR \< 50)
8. Metastatic malignancy
9. Pregnancy
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ottawa Heart Institute Research Corporation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Munir Boodhwani, MD

Role: PRINCIPAL_INVESTIGATOR

Ottawa Heart Institute Research Corporation

Jehangir Appoo, MD

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Locations

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London Health Sciences Centre

London, Ontario, Canada

Site Status RECRUITING

University Health Network

Toronto, Ontario, Canada

Site Status RECRUITING

Montreal Heart Institute

Montreal, Quebec, Canada

Site Status RECRUITING

Institut Universitaire De Cardiologie Et De Pneumologie de Québec

Québec, Quebec, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Khatira Mehdiyeva

Role: CONTACT

613-696-7000 ext. 18328

Alice Black

Role: CONTACT

403-389-8958 ext. 613-696-7230

Facility Contacts

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Stephen Mardell

Role: primary

5196858500 ext. 34070

Waleed Alnimr

Role: primary

416 340 4800

Asma Hamlili

Role: primary

514-376-3330 ext. 3725

Alexandre Bergeron

Role: backup

514-376-3330 ext. 3725

Annie Bergeron

Role: primary

418-656-8711 ext. 2768

References

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Elbatarny M, Stevens LM, Dagenais F, Peterson MD, Vervoort D, El-Hamamsy I, Moon M, Al-Atassi T, Chung J, Boodhwani M, Chu MWA, Ouzounian M; Canadian Thoracic Aortic Collaborative Investigators. Hemiarch versus extended arch repair for acute type A dissection: Results from a multicenter national registry. J Thorac Cardiovasc Surg. 2024 Mar;167(3):935-943.e5. doi: 10.1016/j.jtcvs.2023.04.012. Epub 2023 Apr 20.

Reference Type DERIVED
PMID: 37084820 (View on PubMed)

Other Identifiers

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HEADSTART

Identifier Type: -

Identifier Source: org_study_id

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