Surgical outcomes of total arch replacement with modified elephant trunk technique in type A aortic dissection: insights from single-center experience

2022 ◽  
pp. 021849232110701
Author(s):  
Jian Li ◽  
Yueyun Zhou ◽  
Wei Qin ◽  
Cunhua Su ◽  
Fuhua Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement ◽  
Hospital Death ◽  
Acute Type ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Visceral Malperfusion ◽  
Cerebral Malperfusion

Background Total arch replacement with modified elephant trunk technique plays an important role in treating acute type A aortic dissection in China. We aim to summarize the therapeutic effects of this procedure in our center over a 17-year period. Methods Consecutive patients treated at our hospital due to type A aortic dissection from January 2004 to January 2021 were studied. Relevant data of these patients undergoing total arch replacement with modified elephant trunk technique were collected and analyzed. Results A total of 589 patients were included with a mean age of 53.1 ± 12.2 years. The mean of cardiopulmonary bypass, cross-clamping, and selected cerebral perfusion time were 199.6 ± 41.9, 119.0 ± 27.2, and 25.1 ± 5.0 min, respectively. In-hospital death occurred in 46 patients. Multivariate analysis identified four significant risk factors for in-hospital mortality: preexisting renal hypoperfusion (OR 5.43; 95% CI 1.31 – 22.44; P = 0.020), cerebral malperfusion (OR 11.87; 95% CI 4.13 – 34.12; P < 0.001), visceral malperfusion (OR 4.27; 95% CI 1.01 – 18.14; P = 0.049), and cross-clamp time ≥ 130 min (OR 3.26; 95% CI 1.72 – 6.19; P < 0.001). The 5, 10, and 15 years survival rates were 86.4%, 82.6%, and 70.2%, respectively. Conclusions Total arch replacement with modified elephant trunk technique is an effective treatment for acute type A aortic dissection with satisfactory perioperative results. Patients with preexisting renal hypoperfusion, cerebral malperfusion, visceral malperfusion, and long cross-clamp time are at a higher risk of in-hospital death.

Is Emergency Total Arch Replacement With a Modified Elephant Trunk Technique Justified for Acute Type A Aortic Dissection?

2007 ◽  
Vol 84 (5) ◽  
pp. 1585-1591 ◽  
Author(s):  
Hirotaka Watanuki ◽  
Hitoshi Ogino ◽  
Kenji Minatoya ◽  
Hitoshi Matsuda ◽  
Hiroaki Sasaki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement ◽  
Acute Type ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique

scholarly journals Outcome of Frozen Elephant Trunk Technique for Acute Type A Aortic Dissection

Medicine ◽  
2015 ◽  
Vol 94 (16) ◽  
pp. e694 ◽  
Author(s):  
Hui-Han Lin ◽  
Shou-Fu Liao ◽  
Ching-Feng Wu ◽  
Ping-Chun Li ◽  
Ming-Li Li
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

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

2014 ◽  
Vol 148 (2) ◽  
pp. 561-565 ◽  
Author(s):  
Kentaro Tamura ◽  
Naomichi Uchida ◽  
Akira Katayama ◽  
Miwa Sutoh ◽  
Masatsugu Kuraoka ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Frozen elephant trunk technique for acute type A aortic dissection

2012 ◽  
Vol 2012 (0) ◽  
pp. mms012-mms012
Author(s):  
G. Weiss ◽  
M. Gorlitzer ◽  
S. Folkmann ◽  
F. Waldenberger ◽  
R. Moidl ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

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.

scholarly journals Comparative study of the frozen elephant trunk and classical elephant trunk techniques to supplement total arch replacement for acute type A aortic dissection†

2019 ◽  
Vol 56 (3) ◽  
pp. 579-586 ◽  
Author(s):  
Yosuke Inoue ◽  
Hitoshi Matsuda ◽  
Atsushi Omura ◽  
Yoshimasa Seike ◽  
Kyokun Uehara ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Aortic Dissection ◽  
Pulmonary Vein ◽  
Type A ◽  
Total Arch Replacement ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Cord Injury

Abstract OBJECTIVES In patients with acute type A aortic dissection, the use of the frozen elephant trunk (FET) procedure with total arch replacement (TAR) has been indicated for emergency operations to obtain thrombosis of the distal false lumen (FL). However, data comparing the FET and the classical elephant trunk (CET) procedures, including the incidences of mortality, morbidity, spinal cord injury and aortic remodelling, have not yet been reported. The goal of this study was to compare the early outcomes of TAR with the FET and the CET procedures. METHODS The past 7 years of medical records of 323 patients with type A aortic dissection who underwent emergency surgery were reviewed retrospectively, and 148 patients who underwent TAR were shortlisted for the study. First, the patients were divided into 2 groups, the CET group (n = 115; age 65 ± 12 years) and FET group (n = 33; 67 ± 11 years), to compare the early operative outcomes, including mortality and morbidity. Second, 86 patients (CET 56; FET 30) fulfilling the inclusive criteria (inserted length of elephant trunk ≥5 cm, involvement of dissection at the descending aorta and sufficient computed tomographic evaluation at ≥6 months after the operation) were compared to evaluate the patency and diameter of the FL at each segment of the downstream aorta. RESULTS The in-hospital mortality rate was 8.1% (12/148), without significant differences between the 2 groups (CET 8.7% vs FET 6.1%; P = 1). No spinal cord ischaemia was encountered in either group. The incidence of postoperative FL patency at the level of the left lower pulmonary vein was 30% in the FET group, which was significantly lower than that in the preoperative state (73%) and in the CET group (77%). The downsizing of the aortic diameter at the distal edge of the CET or the FET, the left lower pulmonary vein and the coeliac axis was significant in the FET group 6 months after TAR. CONCLUSIONS According to our initial experience, the FET compared to the CET procedure showed comparable early complications and an advantage concerning FL thrombosis and aortic remodelling at early follow-up examinations.

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