Total Arch Replacement Versus More Conservative Management in Type A Acute Aortic Dissection

Abstract OBJECTIVES We investigated the outcomes of total arch replacement with frozen elephant trunk (FET) for Stanford type A acute aortic dissection and the patterns of postoperative aortic remodelling from computed tomographic (CT) findings. METHODS From April 2015 to November 2018, we performed total arch replacement with FET for Stanford type A aortic dissection in 30 patients. Postoperative contrast-enhanced CT showed the position of the FET distal end, the number and the site of communications between the lumina and the presence or absence of aortic remodelling. RESULTS Primary entry tear was found in the ascending aorta (n = 6), proximal arch (n = 6), aortic arch (n = 11) and distal arch (n = 7). The mean diameter and length of FET were 26 ± 2 and 84 ± 18 mm, respectively. Postoperative contrast-enhanced CT was performed in 26 patients. When the number of communications between the lumina was 0, complete aortic remodelling was achieved in all cases (n = 12). In the case of the most proximal tear in the descending aorta (n = 9), aortic remodelling was not recognized in 3 cases, and additional TEVAR was performed because of diameter enlargement. In the remaining 6 patients, neither aortic remodelling nor aortic diameter enlargement was recognized. When the most proximal tear was below the diaphragm (n = 5), aortic remodelling occurred up to the most proximal tear, but not in the periphery. CONCLUSIONS We investigated the patterns of aortic remodelling after total arch replacement with FET for Stanford type A aortic dissection from postoperative CT findings. Regardless of the position of the most proximal tear in the descending aorta, aortic remodelling did not occur as long as the most proximal tear was located in the descending aorta. When the most proximal tear occurred in the descending aorta, TEVAR as a pre-emptive treatment can be effective in preventing postoperative aortic adverse events.

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Long-term outcomes of total arch replacement with the non-frozen elephant trunk technique for Stanford Type A acute aortic dissection†

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivy094 ◽

2018 ◽

Vol 27 (3) ◽

pp. 455-460 ◽

Cited By ~ 7

Author(s):

Yosuke Inoue ◽

Hitoshi Matsuda ◽

Atsushi Omura ◽

Yoshimasa Seike ◽

Kyokun Uehara ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Total Arch Replacement ◽

Frozen Elephant Trunk ◽

Long Term Outcomes ◽

Elephant Trunk ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

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Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz154 ◽

2019 ◽

Vol 29 (5) ◽

pp. 753-760 ◽

Cited By ~ 3

Author(s):

Akira Furutachi ◽

Masanori Takamatsu ◽

Eijiro Nogami ◽

Kohei Hamada ◽

Junji Yunoki ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Total Arch Replacement ◽

Lumen Area ◽

Frozen Elephant Trunk ◽

True Lumen ◽

Elephant Trunk ◽

Elephant Trunk Technique

Abstract OBJECTIVES The aim of this study was to evaluate the outcomes of the frozen elephant trunk (FET) technique, using the J Graft FROZENIX for Stanford type A acute aortic dissection, in comparison with the unfrozen elephant trunk technique. METHODS Between January 2010 and August 2018, we performed total arch replacement for Stanford type A acute aortic dissection in our hospital. Thirty patients were treated by the elephant trunk procedure (ET group), and 20 patients were treated by the FET procedure (FET group). To evaluate aortic remodelling, we measured the area of the aorta, the true lumen and the false lumen at 12 months of follow-up. RESULTS Preoperative characteristics and operation time were not significantly different between the 2 groups. The quantity of blood transfused was much greater in the ET group than in the FET group. Resection or closure of the most proximal entry tear was obtained in 73.3% (22 out of 30 patients) in the ET group and 100% (20 out of 20 patients) in the FET group (P = 0.015). There was no case that had recurrent nerve palsy or paraplegia in the FET group. Stent graft-induced new entry occurred in 3 cases (15.8%) in the FET group. There were no significant differences between the 2 groups in aortic area, true lumen area or false lumen area. CONCLUSIONS Total arch replacement with the FET technique in Stanford type A acute aortic dissection carries a risk of distinct complications; however, with thorough advance planning, it should be possible to safely institute this treatment. Further randomization, with a comparison of each technique, is required to provide clear conclusions whether the FET is useful for acute Stanford type A aortic dissection.

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Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience

Texas Heart Institute Journal ◽

10.14503/thij-15-5379 ◽

2016 ◽

Vol 43 (6) ◽

pp. 488-495 ◽

Cited By ~ 14

Author(s):

Antonio Lio ◽

Francesca Nicolò ◽

Emanuele Bovio ◽

Andrea Serrao ◽

Jacob Zeitani ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Acute Aortic Dissection ◽

Operative Mortality ◽

Type A ◽

Total Arch Replacement ◽

Operative Death ◽

Aortic Arch Surgery ◽

Intermediate Outcomes ◽

Hemiarch Replacement

We retrospectively evaluated early and intermediate outcomes of aortic arch surgery in patients with type A acute aortic dissection (AAD), investigating the effect of arch surgery extension on postoperative results. From January 2006 through July 2013, 201 patients with type A AAD underwent urgent corrective surgery at our institution. Of the 92 patients chosen for this study, 59 underwent hemiarch replacement (hemiarch group), and 33 underwent total arch replacement (total arch group) in conjunction with ascending aorta replacement. The operative mortality rate was 22%. Total arch replacement was associated with a 33% risk of operative death, versus 15% for hemiarch (P=0.044). Multivariable analysis found these independent predictors of operative death: age (odds ratio [OR]=1.13/yr; 95% confidence interval [CI], 1.04–1.23; P=0.002), body mass index >30 kg/m2 (OR=9.9; 95% CI, 1.28–19; P=0.028), postoperative low cardiac output (OR=10.6; 95% CI, 1.18–25; P=0.035), and total arch replacement (OR=8.8; 95% CI, 1.39–15; P=0.021) The mean overall 5-year survival rate was 59.3% ± 5.5%, and mean 5-year freedom from distal reintervention was 95.4% ± 3.2% (P=NS). In type A AAD, aortic arch surgery is still associated with high operative mortality rates; hemiarch replacement can be performed more safely than total arch replacement. Rates of distal aortic reoperation were not different between the 2 surgical strategies.

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