Hypothermic Circulatory Arrest Time affects neurological outcomes of Frozen Elephant Trunk for Acute Type A Aortic Dissection: a systematic review and meta-analysis

Background: The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta-analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post-operative neurologic outcomes. Methods: A standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses search was conducted for all observational studies of patients diagnosed with ATAAD undergoing total arch replacement with FET reporting in-hospital mortality, bleeding, and neurological outcomes. A random-effect meta-analysis was performed using STATA software (StataCorp, TX, USA). Results: Thirty-five studies were eligible for the present meta-analysis, including 3211 patients with ATAAD who underwent total arch replacement with FET. The pooled estimate for in-hospital mortality, postoperative stroke, and spinal cord injury were 7% (95% CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3% (95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta-regression revealed that with increasing the duration of hypothermic circulatory arrest time, the effect sizes for postoperative stroke and SCI enhances. Conclusions: It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.

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Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis

Journal of Cardiac Surgery ◽

10.1111/jocs.15700 ◽

2021 ◽

Author(s):

Mostafa Mousavizadeh ◽

Mahdi Daliri ◽

Hadi Abo Aljadayel ◽

Idhrees Mohammed ◽

Yousef Rezaei ◽

...

Keyword(s):

Systematic Review ◽

Aortic Dissection ◽

Circulatory Arrest ◽

Meta Analysis ◽

Type A ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Type A Aortic Dissection ◽

Neurological Outcomes

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Methodological quality of a meta-analysis precedes its clinical significance

10.22541/au.162436912.20862425/v1 ◽

2021 ◽

Author(s):

Jinlin Wu ◽

Tucheng Sun ◽

Ruixin Fan

Keyword(s):

Systematic Review ◽

Methodological Quality ◽

Circulatory Arrest ◽

Meta Analysis ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Type A Aortic Dissection ◽

Neurological Outcomes

In this letter, we commented on several issues of the recent study entitled “Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis” by Dr. Mousavizadeh et al. We hope to improve the clarity of this research and call attention to the methodological quality of performing a meta-analysis.

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Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa411 ◽

2020 ◽

Author(s):

Homare Okamura ◽

Yuichiro Kitada ◽

Atsushi Miyagawa ◽

Mamoru Arakawa ◽

Hideo Adachi

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

Type A ◽

Hypothermic Circulatory Arrest ◽

Aortic Diameter ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Type A Aortic Dissection

Abstract OBJECTIVES We investigated the outcomes of a fenestrated frozen elephant trunk (FET) technique performed without reconstruction of one or more supra-aortic vessels for aortic repair in patients with acute type A aortic dissection. METHODS We investigated 22 patients who underwent the fenestrated FET technique for acute type A aortic dissection at our hospital between December 2017 and April 2020. The most common symptom was chest pain and/or back pain. Nine patients presented with malperfusion and 1 with cardiac arrest, preoperatively. A FET was deployed under hypothermic circulatory arrest and manually fenestrated under direct vision. Single fenestration was made in the FET in 15 patients, 2 fenestrations in 5 patients and a total fenestrated technique in 2 patients. Concomitant procedures were performed in 5 patients. RESULTS The cardiopulmonary bypass, aortic cross-clamp and hypothermic circulatory arrest times were 181 ± 49, 106 ± 43 and 37 ± 7 min, respectively. In-hospital mortality, stroke, or recurrent nerve injury did not occur in any patient. One patient developed paraparesis, which completely recovered at discharge. During the follow-up period (mean 18 ± 7 months), 1 patient died of heart failure. Fenestration site occlusion did not occur. Follow-up computed tomography (mean 12 ± 6 months postoperatively) revealed that the maximal aortic diameter remained unchanged at the levels of the distal end of the FET, the 10th thoracic vertebra and the coeliac artery; however, the aortic diameter was significantly reduced at the level of the pulmonary artery bifurcation. CONCLUSIONS The fenestrated FET technique is a simple, safe and effective procedure for selected patients with acute type A aortic dissection.

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