BACKGROUND The Dissected Aorta Repair Through Stent (DARTS) implantation trial is a prospective clinical trial in patients with acute DeBakey Type I dissection. Herein, we report the 5-year outcomes of the DARTS trial. METHODS The DARTS trial included patients who underwent acute DeBakey Type I dissection repair with the Artivion AMDS hybrid prosthesis from March 2017 to January 2019. Clinical outcomes were collected in patients for up to 5 years. Significant change in total aortic diameter was considered as >5 mm growth/year and the false lumen (FL) was considered patent, partially thrombosed, or completely thrombosed. RESULTS Forty-six patients met eligibility criteria and were included in the DARTS trial. Twelve patients (26.1%) passed away before 5-year follow-up, 4 patients were lost to follow-up, and 3 withdrew from the trial. New stroke occurred in 10 patients (21.7%). Rates of new spinal cord ischemia, distal anastomotic new entry tears, and distal stent-induced new entries were 0. Total aortic diameter was stable in the majority of patients over 5 years. FL patency decreased over time up to 5 years with 75%-95% FL thrombosis in zones 0-5. Distal FL communications were found to be associated with distal aortic growth, with no other reliable predictors of adverse aortic remodeling identified. Most patients (37 of 46; 80%), were free from any aortic procedure and 43 of 46 (94%) were free from reoperation through 5 years. CONCLUSIONS The 5-year outcomes of the DARTS trial demonstrate the safety and efficacy of the AMDS. Measures of aortic growth were generally favorable, with the majority of patients experiencing positive aortic remodeling over 5 years. (c) 2026 The Authors. Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Background Robotic techniques are increasingly used for complex diaphragmatic hernia repair. However, their safety in type IV hiatal hernias remains uncertain. This study evaluated perioperative outcomes across surgical approaches. Methods Study investigators performed a retrospective cohort study using The Society of Thoracic Surgeons General Thoracic Surgery Database, identifying adults undergoing elective type IV hiatal hernia repair between 2018 and 2022. Patients were stratified by operative approach: robotic, laparoscopic, laparotomy, and thoracotomy. The primary outcome was a composite of major postoperative events. Secondary outcomes included postoperative invasive intervention, initial intensive care unit admission, readmission, and mortality. Multivariable logistic regression adjusted for demographics, comorbidities, prior thoracic surgery, and procedural factors, with robotic repair as the reference. Results A total of 2714 patients underwent repair: 1281 laparoscopic repair (47.2%), 1112 robotic repair (41.0%), 128 laparotomy (4.7%), and 193 thoracotomy (7.1%). Major postoperative events occurred most frequently after thoracotomy (42.5%) and laparotomy (35.9%), compared with laparoscopic (27.5%) and robotic repair (23.3%). In adjusted models, open approaches were associated with higher odds of major postoperative events compared with robotic repair (laparotomy odds ratio, 1.77; thoracotomy odds ratio, 2.54), whereas laparoscopic repair was not significantly different. Readmission and mortality were similar across approaches. Conclusions Minimally invasive approaches, including laparoscopic and robotic techniques, are associated with favorable perioperative outcomes compared with open repair. These findings support the use of minimally invasive surgery for type IV hiatal hernias when clinically appropriate.
