Hybrid and frozen elephant trunk for total arch replacement in DeBakey type I dissection

Zhang, Liang; Yu, Cuntao; Yang, Xinying; Sun, Xiaogang; Qiu, Juntao; Jiang, Wenxiang; De, Wang

doi:10.1016/j.jtcvs.2019.01.020

Cited by 34 publications

(32 citation statements)

References 25 publications

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“…Presently, we do not have a specific risk score to assist and evaluate the patients who underwent aortic surgery (22). HAR may be a better option for patients with preoperative liver and kidney insufficiency or organ malperfusion (19). But the stroke rate and the number of late aortic events was higher in the HAR group (compared with TAR+FET).…”

Section: Commentmentioning

confidence: 99%

“…But it has not been widely adopted for type I aortic dissection throughout the world. Hemiarch or ascending aortic replacement yields favorable early outcomes, but they are associated with poor false lumen remodeling and high longterm reoperation rates (19). TAR+FET technique can effectively remove arch lesions, and promoting obliteration of the false lumen (1,20).…”

Section: Commentmentioning

confidence: 99%

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

Xie

Dai

et al. 2021

Front. Cardiovasc. Med.

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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.

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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

Xie

Dai

et al. 2021

Front. Cardiovasc. Med.

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“…Although a pooled analysis showed that aortic arch repair in patients with TAAD can be performed without increased risk [ 3 ], previous studies [ 16 ] and our experience showed that aortic arch surgery was associated with increased mortality (30-day: 25.2% vs. 14.6%; 10-year: 53.3% vs. 33.6%, adjusted HR 2.770, 95%CI 1.562–4.913). Furthermore, most studies demonstrated that aortic arch repair with or without the use of frozen elephant trunk technique seems not to decrease the risk of distal aortic reoperation [ 6 , 7 , 8 , 9 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], whose freedom rates at 10 years may range from 78.0% to 92.9% [ 17 , 21 ]. We recognize that there are also studies from series including mostly ascending aorta/hemiarch repairs reporting 10-year freedom from reoperation as low as 61% to 78% [ 15 , 23 ], and decreased aortic reoperations after total arch replacement [ 15 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Late Outcome after Surgery for Type-A Aortic Dissection

Jormalainen

Raivio

Biancari

et al. 2020

JCM

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The aim of this study was to evaluate all-cause mortality and aortic reoperations after surgery for Stanford type A aortic dissection (TAAD). We evaluated the late outcome of patients who underwent surgery for acute TAAD from January 2005 to December 2017 at the Helsinki University Hospital, Finland. We studied 309 patients (DeBakey type I TAAD: 89.3%) who underwent repair of TAAD. Aortic root repair was performed in 94 patients (30.4%), hemiarch repair in 264 patients (85.4%) and partial/total aortic arch repair in 32 patients (10.4%). Hospital mortality was 13.6%. At 10 years, all-cause mortality was 34.9%, and the cumulative incidence of aortic reoperation or late aortic-related death was 15.6%, of any aortic reoperation 14.6%, reoperation on the aortic root 6.6%, on the aortic arch, descending thoracic and/or abdominal aorta 8.7%, on the descending thoracic and/or abdominal aorta 6.4%, and on the abdominal aorta 3.8%. At 10 years, cumulative incidence of reoperation on the distal aorta was higher in patients with a diameter of the descending thoracic aorta ≥35 mm at primary surgery (cumulative incidence in the overall series: 13.2% vs. 4.0%, SHR 3.993, 95%CI 1.316–12.120; DeBakey type I aortic dissection: 13.6% vs. 4.5%, SHR 3.610, 95%CI 1.193–10.913; patients with dissected descending thoracic aorta: 15.8% vs. 5.9%, SHR 3.211, 95%CI 1.067–9.664). In conclusion, surgical repair of TAAD limited to the aortic segments involved by the intimal tear was associated with favorable survival and a low rate of aortic reoperations. However, patients with enlarged descending thoracic aorta at primary surgery had higher risk of late reoperation. Half of the distal aortic reinterventions were performed on the abdominal aorta.

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“…The time that DHCA is safe is 30-40 min; the shorter the time is, the better [21,22]. If surgeons can not complete high-quality complex surgery as soon as Bentall procedure 1 (4%) 30% [7] 29% [8] Reconstruction of the sinus of Valsalva 5 (20%) 17% [7] 33% [8] Coronary artery bypass graft 1 (4%) 9% [7] CPB (min) 207 ± 52 201 ± 51 [7] 196 ± 63 [8] Aortic cross-clamp time (min) 114 ± 39 111 ± 31 [7] 100 ± 29 [8] Circulatory arrest (sec) 38 ± 16 1440 ± 480 [7] 1390 ± 487 [8] Surgery duration (min) 463 ± 136 408 ± 125 [8] Lowest nasopharyngeal temperature(°C) 30 25 [7] 20 [8] Blood loss during operation (mL) 841 ± 85 947 ± 773 [8] Blood product use Renal dysfunction requiring dialysis 1 (4%) 4.3% [7] 9.6% [8] Prolonged intubation (including Tracheostomy) 3 (12%) 17.1 (10.9-24.4) % [9] Recurrent nerve palsy 0 1% [7] Paraplegia 0 1.8% [7] 4.4% [8] 1.95 (1.04-3.12) % [9] Hepatic insufficiency 0 31.4% [8] Reexploration for bleeding 0 2.5% [7] 3.7% [8] possible during safe operational time window, patients may be left with serious complications. So they need relatively advanced skill, much experience and excellent psychological quality.…”

Section: Discussionmentioning

confidence: 99%

One minute of circulatory arrest for acute type A aortic dissection --------- a simple operation for acute type A aortic dissection (AAAD)

Jiang

Huo

Liu

et al. 2020

J Cardiothorac Surg

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Background Sun’s procedure is currently recognized as the standard procedure for acute type A aortic dissection (AAAD). But the operation istoo difficult for beginners. We hope to reduce the difficulty and complications of this operation. Methods The aortic arch was immediately cross-clamped after the stented graft was inserted into the distal aorta. Thereafter, the lower-body perfusion was restored. Then, anastomosis was performed between the proximal stent graft and the distal 4-branched Dacron graft. The other arteries were anastomosed to the arched branch of the 4-branched graft. Results The cardiopulmonary bypass (CPB) time was (207 ± 52) min, and the aortic cross-clamp time was (114 ± 39) min. The circulatory arrest time was (38 ± 16) sec. One patient (4%) died. The incidence of complications was stroke (4%), renal dysfunction requiring dialysis (4%), prolonged intubation(12%). Conclusions The time of circulatory arrest in this operation is less than 1 min, which can avoid the complications caused by DHCA and decrease risk of bleeding and complexity by shifting anastomosis more proximally. The effect of our operation is similar to and even better than that of Sun’s procedure. It does not even require relatively advanced skill, much experience and excellent psychological quality, especially suitable for beginners.

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Hybrid and frozen elephant trunk for total arch replacement in DeBakey type I dissection

Cited by 34 publications

References 25 publications

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

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

Late Outcome after Surgery for Type-A Aortic Dissection

One minute of circulatory arrest for acute type A aortic dissection --------- a simple operation for acute type A aortic dissection (AAAD)

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