scholarly journals Different aortic arch surgery methods for type A aortic dissection: clinical outcomes and follow-up results

2020 ◽  
Vol 31 (2) ◽  
pp. 254-262
Author(s):  
Yunxing Xue ◽  
Jun Pan ◽  
Hailong Cao ◽  
Fudong Fan ◽  
Xuan Luo ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Clinical Outcomes ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Arch Surgery

Abstract OBJECTIVES The aim of this study was to investigate the clinical outcomes and follow-up results among 5 main aortic arch surgery methods for type A aortic dissection in a single centre. METHODS From 2002 to 2018, 958 type A aortic dissection patients who received surgical repair were divided into 5 groups according to the arch surgery method: hemiarch replacement (n = 206), island arch replacement (n = 54), total arch replacement with frozen elephant trunk (n = 425), triple-branched stent (n = 39) and fenestrated stent (n = 234). The indications for the different arch methods were related to the patient’s preoperative status, the location and extent of the dissection and the surgical ability of the surgeons. A comparative study was performed to identify the differences in the perioperative data, and the Kaplan–Meier analysis was used to assess the long-term survival and reintervention rates. Thirty matched surviving patients that were included in each group completed Computed tomography angiography to determine long-term reshaping effect. RESULTS The 30-day mortality rate was 15.8%, and there was no difference among the 5 groups (P = 0.848). The follow-up survival rates were similar among the 5 groups (P = 0.130), and the same was true for patients without reintervention (P = 0.471). In the propensity matching study, patients with stents (frozen elephant trunk, triple-branched stent, fenestrated stent) had a slower aortic dilation rate and a higher ratio of thrombosis in the false lumen at the descending aortic and abdominal aortic levels than patients without stents. CONCLUSIONS No standard method is available for arch surgery, and indications and long-term effects should be identified with clinical data. In our experiences, simpler surgical procedures could reduce mortality in critically ill patients and stents in the distal aorta could improve long-term reshape effects.

scholarly journals Long-term outcomes of frozen elephant trunk for type A aortic dissection in patients with Marfan syndrome

2017 ◽  
Vol 154 (4) ◽  
pp. 1175-1189.e2 ◽  
Author(s):  
Wei-Guo Ma ◽  
Wei Zhang ◽  
Jun-Ming Zhu ◽  
Bulat A. Ziganshin ◽  
Ai-Hua Zhi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Long Term Outcomes ◽  
Elephant Trunk ◽  
Type A Aortic Dissection

scholarly journals ­­ A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

2020 ◽  
Author(s):  
Shi-bo Song ◽  
Po-yuan Hu ◽  
Xi-jie Wu ◽  
Yong Sun ◽  
Shi-hao Cai ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Short Term ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract Background Acute Stanford type A aortic dissection is a lethal event with a high mortality rate and requires emergency intervention. The goal of salvage surgery is to keep the patient alive by addressing the problems of severe aortic regurgitation, tamponade, primary tear and malperfusion of organs,and, if possible, to prevent the late dissection-related complications in the proximal and downstream aorta. No standard treatment or techniques have been determined for this disease. We aim to describe a modified elephant trunk technique for acute type A aortic dissection and report the short-term outcomes of this surgical technique. Methods From February 2018 to August 2019, 16 patients who were diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique procedure at Xiamen Heart Centre (9men; age, 59.21±11.67 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%)had hypertension and poor blood control management. Operative mortality was 6.25%. The primary tears were located in the lesser curve of the aortic arch in 5 patients (31.3%), in the ascending aorta in 9 patients (56.3%), and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery in 14 patients (87.6%) and to the distal descending aorta in 2 patients (12.5%). The time of cardiopulmonary bypass(CPB),cross-clamping and cerebral perfusion were 215± 40.5,140.8±32.3, and 23±6 minutes, respectively. Aortic valve plasty was performed in 15 patients (93.8%). Additionally, the Bentall procedure and coronary artery repair were performed in 1 patient each (6.3%), respectively. The diameters at all levels were greater before discharge than those when on admission to the hospital, except for the diameter of the aortic arch. After 3 months, the diameters at the aortic arch, descending aorta of the diaphragm, bifurcation of the pulmonary artery had increased, but the diameter at the bifurcation level of the common iliac artery had changed little. Only the diameter of the distal stent aorta had increased significantly. Conclusion The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible, and it could be used for organ malperfusion as well. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

scholarly journals Early and long-term results of total arch replacement with the frozen elephant trunk technique for acute type A aortic dissection

2020 ◽  
Vol 58 (4) ◽  
pp. 707-713 ◽  
Author(s):  
Akihiro Yoshitake ◽  
Masato Tochii ◽  
Chiho Tokunaga ◽  
Jun Hayashi ◽  
Akitoshi Takazawa ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Term Survival ◽  
Type A Aortic Dissection ◽  
Long Term Survival

Abstract OBJECTIVES We evaluated the operative and long-term outcomes of the frozen elephant trunk (FET) technique for acute type A aortic dissection. METHODS This study evaluated 426 consecutive patients who underwent aortic repair for acute type A aortic dissection from June 2007 to December 2018 at our centre. Of these, 139 patients underwent total arch replacement with FET (FET group), and 287 underwent other procedures (no FET group). Ninety-two patients in the FET group were matched to 92 patients in the no FET group by using propensity score matching analysis. RESULTS Thirty-day mortality and neurological dysfunction were not significantly different between the FET and no FET groups (1.4% vs 2.4%, P = 0.50 and 5.0% vs 6.3%, P = 0.61, respectively). Long-term survival was better in the FET group than in the no FET group (P = 0.008). Freedom from distal thoracic reintervention was similar in the FET and no FET groups (P = 0.74). In the propensity-matched patients, freedom from aortic-related death was better in the FET group than in the no FET group (P = 0.044). CONCLUSIONS Operative outcomes showed no significant difference between the 2 groups. FET contributes to better long-term survival in patients with acute type A aortic dissection.

Alternatives to the frozen elephant trunk in acute type A aortic dissection

2020 ◽  
pp. 021849232092874
Author(s):  
Bashi V Velayudhan ◽  
A Mohammed Idhrees
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Long Term Results ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Multiple Strategies ◽  
The Cost

Acute type A aortic dissection remains one of the most challenging condition in cardiothoracic surgery, with a high mortality rate. Various improvements and innovations have happened over the years to better the outcome of this lethal condition. The frozen elephant trunk prosthesis has been developed to negate the long-term complications of acute type A aortic dissection, but at the cost of increased morbidity compared to hemiarch replacement. Although hemiarch and total arch replacement seem have less morbidity than the frozen elephant trunk technique, they do not address the long-term complications of the distal dissected aorta. Few surgeons now suggest hybrid aortic arch repair as a solution for acute type A aortic dissection. The long-term results need to be studied in all procedures before standardizing them. Although multiple strategies are evolving, the short-term goal of acute type A aortic dissection has not changed: to save the patient’s life. The surgical strategy has to be tailored according to the patient’s condition and the surgeon’s experience.

scholarly journals The frozen elephant trunk technique for acute retrograde type A aortic dissection: preliminary results

2020 ◽  
Vol 31 (6) ◽  
pp. 813-819
Author(s):  
Daisuke Kaneyuki ◽  
Kenji Mogi ◽  
Hiroyuki Watanabe ◽  
Masayoshi Otsu ◽  
Manabu Sakurai ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Neurological Complications ◽  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Enhanced Computed Tomography

Abstract OBJECTIVES Our goal was to determine the early and midterm outcomes after total arch replacement with the frozen elephant trunk (FET) technique compared to those of the conventional elephant trunk (ET) technique for acute retrograde type A aortic dissection. METHODS Between 2012 and 2019, a total of 49 patients had total arch replacement for acute retrograde type A aortic dissection. Patients were divided into the conventional ET (n = 17) and FET (n = 32) groups. The false lumen status was evaluated using enhanced computed tomography (CT) 1 week postoperatively. The diameter of the downstream aorta was evaluated annually using CT. The median follow-up period was 29 months. RESULTS Preoperative data and neurological complications were not significantly different in the 2 groups. The diameter and length of the ET prosthesis were significantly larger and longer in the FET group. The overall early mortality rate was 10.2% (5/49) with no differences between the 2 groups. The mean follow-up period was significantly longer in the conventional ET group. The rates of freedom from aortic events at 3 years were significantly lower in the FET group. At the level of the distal arch, postoperative false lumen patency was significantly lower and the follow-up aortic diameter was significantly smaller in the FET group. CONCLUSIONS The FET technique facilitates false lumen thrombosis and aortic remodelling at the distal arch level, with fewer adverse aortic events during the follow-up period with acceptable early outcomes; however, these findings are exploratory and require investigation.

scholarly journals Long stent graft for frozen elephant trunk repair in acute type A aortic dissection

2021 ◽  
Author(s):  
Chaojie Wang ◽  
Wenqian Zhang ◽  
Jihai Peng ◽  
Jie He ◽  
Wenliu Xu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aorta ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Remodeling

OBJECTIVES: The frozen elephant trunk (FET) technique has become an important tool in the treatment of acute type A aortic dissection. The aim of this study was to evaluate the effect of long FET on spinal cord injury (SCI) and distal aortic remodeling after acute type A aortic dissection based on clinical and radiological outcomes. METHODS: From January 2018 to November 2019, 158 patients [mean age 51.8 years (range 32 - 78 years), 88.6% male] with acute type A aortic dissection were treated by FET with 100 mm (n=113) or 150 mm (n=45) open hybrid stent graft prosthesis. Patients were divided into two groups according to the length of FET. The clinical and radiological outcomes of the patients were reviewed retrospectively. RESULTS: Postoperative outcomes did not differ significantly: in-hospital mortality (9.7% vs 6.7%, P=0.758) and SCI (5.3% vs 2.2%, P=0.674). Aortic remodeling, which was evaluated by aortic diameter, true lumen diameter, false lumen diameter and the rate of false lumen complete thrombosis, was more positive in long FET group in the descending thoracic aorta during the follow-up period. At the abdominal level, there was no statistically significant difference between the two groups. CONCLUSIONS: The long version of FET does not increase the risk of SCI in patients with acute type A aortic dissection. The application of long FET can achieve better results in terms of remodeling of the thoracic aorta in the short- and medium-term follow-up.

scholarly journals A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Shi-bo Song ◽  
Xi-jie Wu ◽  
Yong Sun ◽  
Shi-hao Cai ◽  
Po-yuan Hu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Short Term ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract Background Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes. Methods From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 56.1 ± 7.6 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB), cross-clamping, and antegrade cerebral perfusion were 215.8 ± 40.5, 140.8 ± 32.3, and 55.1 ± 15.2 min, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling. Conclusions The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

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