Hemiarch vs Extended Arch in Type 1 Aortic Dissection

Last updated: September 17, 2025
Sponsor: Ottawa Heart Institute Research Corporation
Overall Status: Active - Recruiting

Phase

N/A

Condition

Chest Pain

Occlusions

Cardiovascular Disease

Treatment

Hemiarch repair

Extended arch repair

Clinical Study ID

NCT03885635
HEADSTART
  • Ages 18-70
  • All Genders

Study Summary

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.

Eligibility Criteria

Inclusion

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

Study Design

Total Participants: 50
Treatment Group(s): 2
Primary Treatment: Hemiarch repair
Phase:
Study Start date:
July 30, 2024
Estimated Completion Date:
March 31, 2027

Study Description

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.

Connect with a study center

  • University of Calgary

    Calgary, Alberta T2N2T9
    Canada

    Site Not Available

  • Mazankowski Alberta Heart Institute

    Edmonton, Alberta T6G2B7
    Canada

    Site Not Available

  • New Brunswick Heart Centre

    Saint John, New Brunswick E2L4L2
    Canada

    Site Not Available

  • London Health Sciences Centre

    London, Ontario N6A5A5
    Canada

    Site Not Available

  • London Health Sciences Centre

    London 6058560, Ontario 6093943 N6A5A5
    Canada

    Active - Recruiting

  • University Health Network

    Toronto 6167865, Ontario 6093943 M5G 2C4
    Canada

    Active - Recruiting

  • Montreal Heart Institute

    Montreal 6077243, Quebec 6115047 H1T 1C8
    Canada

    Active - Recruiting

  • Institut Universitaire De Cardiologie Et De Pneumologie de Québec

    Québec 6325494, Quebec 6115047 G1V 4G5
    Canada

    Active - Recruiting

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