Background: The Sun procedure has been widely adopted across China for the treatment of acute type A aortic dissection (ATAAD). Although favorable outcomes have been reported from high-volume centers, institutional series offering detailed early data using modern operative protocols remain limited. This study is structured in two parts: first, a review of the literature on the development and reported outcomes of the Sun procedure in different aortic populations across China; and second a presentation of contemporary operative characteristics and early outcomes in patients undergoing the Sun procedure for ATAAD at a single institution.
Methods: A retrospective analysis was conducted on 729 consecutive patients with ATAAD treated at DeltaHealth Hospital from 2016 to 2024. Among these, 573 patients (78.6%) underwent total arch replacement with frozen elephant trunk (FET) using the Sun procedure. Baseline characteristics, operative variables, and early outcomes were analyzed. Neurologic, renal, pulmonary, and systemic complications are reported.
Results: The mean age of patients was 52.7±14.1 years, and 73.5% were male. Cardiac tamponade was present in 19.1% of patients at presentation. The history of cerebrovascular disease was noted in 4.1%, 3.4% had chronic kidney disease and 13.6% had Marfan syndrome. In-hospital mortality was 4.1%. Major complications included stroke (10.2%), spinal cord injury (SCI) (2.6%), acute renal failure (8.4%), gastrointestinal complications (4.1%), and reoperation for bleeding (14.3%). Sternal dehiscence and limb ischemia occurred in 1.8% and 1.6% of patients, respectively. Outcomes were achieved despite the presence of significant preoperative malperfusion syndromes, cerebral (8.2%), coronary (13.6%), and spinal cord malperfusion (2.2%).
Conclusions: The Chinese experience with the Sun procedure highlights the potential of standardized surgical strategies in complex aortic disease. This dataset affirms the technique’s safety, durability, and adaptability across acute, chronic, and heritable aortic pathologies.