Can a 'branch-first' approach to aortic arch replacement be safely utilized in Stanford type A acute aortic syndromes?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Can a "branch-first" approach to aortic arch replacement be safely utilized in Stanford type A acute aortic syndromes?' Altogether 64 papers were found using the reported searches, of which 10represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All papers included in this BET reported acceptable mortality and/or neurological outcomes in comparison to currently published standards for traditional repair. We conclude that while there is a need for larger series, direct comparison and long-term follow-up, the 'branch-first' approach to aortic arch replacement has been safely performed in several centres in the setting of acute aortic syndromes with results demonstrating acceptable mortality, neurological outcomes and mid-term survival.