Early Outcomes of Three Total Arch Replacement Strategies for DeBakey Type I Aortic Dissection

Abstract

Background: This study employed three surgical techniques: total arch replacement (TAR) with frozen elephant trunk (FET), aortic balloon occlusion technique (ABO) and hybrid aortic arch repair (HAR) on patients with type I aortic dissection in Fuwai Hospital, aiming to compare the early outcomes of these surgical armamentariums.Methods: From January 2016 to December 2018, an overall 633 patients (431 of TAR+FET, 122 of HAR, and 80 of ABO) with type I aortic dissection were included in the study. Thirty-day mortality, stroke, paraplegia, re-exploration for bleeding, and renal replacement therapy were compared using the matching weight method (MWM).Results: After MWM process, the baseline characteristics were comparable among three TAR groups. It showed that ABO group had the longest cardiopulmonary bypass (p < 0.001) and aortic cross-clamp time (p < 0.001), while the operation time was longest in the HAR group (p = 0.039). There was no significant difference in 30-day mortality among groups (p = 0.783). Furthermore, the incidence of stroke (p = 0.679), paraplegia (p = 0.104), re-exploration for bleeding (p = 0.313), and CRRT (p = 0.834) demonstrated no significant difference. Of note, no significant differences were found regarding these outcomes even before using MWM.Conclusions: Based on the early outcomes, the three TAR approaches were equally applicable to type I aortic dissection. We may choose the specific procedure relatively flexibly according to patient status and surgeon's expertise. Importantly, long-term investigations are warranted to determine whether above approaches remain to be of equivalent efficacy and safety.

Hybrid total arch replacement via ministernotomy for Stanford type A aortic dissection

“…The two procedures compared in our study significantly differed in such characteristics, as post-operative in-hospital time (20 vs. 24; p = 0.002) and post-operative pulmonary complications (60.4% vs. 83.7%; p < 0.001). Except for the comparable short-term outcomes, the two groups exhibited significant differences in intraoperative variables, in line with the previous studies demonstrating that the HTAR procedure decreased the time of CPB, ACC, as well as the operation duration time ( 20 ). Besides, the use of HTAR via ministernotomy reduced the intraoperatively needed blood transfusion volume.…”

“…Since the HTAR approach was first implemented in 2000 by J.A. Macierewicz et al ( 19 ), many cardiovascular centers applied it for over a decade and their data show that HTAR has achieved desirable early and long-term clinical outcomes ( 9 , 20 ). Our method of HTAR via upper ministernotomy procedure has similar indications as the conventional HTAR approach.…”

Analysing debranching techniques in Frozen Elephant Trunk procedures: a narrative literature review

“…In the 7 non-comparative arch zone 2 and proximal studies, one reported both 30-day and in-hospital mortality ( 19 ), four in-hospital ( 18 , 25 , 27 , 28 ) and only two 30-day mortality ( 26 , 29 ). Here, the overall mortality rate ranged from 2.8–9.2% with an average rate of 5.4% ( Table 3 ).…”

Hybrid Treatment of Complex Diseases of the Aortic Arch and Descending Thoracic Aorta by Frozen Elephant Trunk Technique

“…However, pre-existing malperfusion syndromes have been associated with higher mortality after the procedure [44]. In the setting of type A AAD, TAR-FET can be performed with acceptable perioperative outcomes as compared with classical limited repairs in centers with expertise and adequate patient selection [9,45]. A recent meta-analysis of 17 studies, including 1300 patients undergoing TAR-FET for AAD, reported an average in-hospital mortality of 7.8%, ranging from 0% to 18.2% [46].…”