Strategy for acute DeBakey type I aortic dissection considering midterm results: a retrospective cohort study comparing ascending aortic replacement and total arch replacement with frozen elephant trunk technique.

Autor: Takagi S; Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan. sho.takagi25@gmail.com., Goto Y; Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan., Yanagisawa J; Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan., Ogihara Y; Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan., Okawa Y; Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic surgery [J Cardiothorac Surg] 2024 Jan 22; Vol. 19 (1), pp. 15. Date of Electronic Publication: 2024 Jan 22.
DOI: 10.1186/s13019-024-02484-6
Abstrakt: Background: Acute type A aortic dissection is treated with an emergency procedure that uses ascending aortic replacement (AAR). However, to avoid a residual dissected aorta with a false lumen, total arch replacement (TAR) is required. The frozen elephant trunk (FET) technique is a promising surgical approach that promotes false lumen obliteration in a single step. Therefore, this retrospective single-center study aimed to evaluate the operative outcomes of AAR and TAR with FET.
Methods: Between 2007 and 2021, 143 patients with acute DeBakey type I aortic dissection underwent a central repair using AAR (n = 95) or TAR with FET (n = 43). All perioperative variables, the duration of all-cause mortality, and aortic events defined as dilatation of the distal aorta > 5 cm, new occurrences of aortic dissection, distal aortic surgery, and distal aortic rupture were recorded. We compared these perioperative variables and mid-term results with an additional focus on distal aortic events.
Results: Patient background data did not differ between the two groups. Perioperative results for the TAR with FET group vs the AAR group showed similar operative times (306 vs 298 min, P = 0.862), but the TAR group had longer cardiopulmonary bypass times (154 vs 179 min, P < 0.001). The freedom from all-cause death for the TAR vs AAR groups using the Kaplan-Meier method was 81.9% vs 85.4% and 78.0% vs 85.4% (P = 0.407) at 1 and 3 years, respectively. Freedom from aorta-related events was 90.6% vs 97.6% and 69.3% vs 87.0% (P = 0.034) at 1 and 3 years, respectively.
Conclusions: TAR with FET had comparable perioperative results to AAR in acute DeBakey type I aortic dissection and was considered a valuable method to avoid aorta-related events in the midterm.
(© 2024. The Author(s).)
Databáze: MEDLINE
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