Outcomes of long versus short stent cronus hybrid prosthesis in type A aortic dissection: A single centre experience

Abstract

Objectives The frozen elephant trunk (FET) technique has become an important tool in the treatment of acute type A aortic dissection. The aim of this study was to evaluate the effect of long FET on spinal cord injury (SCI) and distal aortic remodeling after acute type A aortic dissection based on clinical and radiological outcomes. Methods From January 2018 to November 2019, 158 patients (mean age 51.8 years [range: 32–78 years], 88.6% male) with acute type A aortic dissection were treated by FET with 100 mm (n = 113) or 150 mm (n = 45) open hybrid stent graft prosthesis. Patients were divided into two groups according to the length of FET. The clinical and radiological outcomes of the patients were reviewed retrospectively. Results Postoperative outcomes did not differ significantly: in‐hospital mortality (9.7% vs. 6.7%, p = .758) and SCI (5.3% vs. 2.2%, p = .674). Aortic remodeling, which was evaluated by aortic diameter, true lumen diameter, false lumen (FL) diameter and the rate of FL complete thrombosis, was more positive in long FET group in the descending thoracic aorta during the follow‐up period. At the abdominal level, there was no statistically significant difference between the two groups. Conclusions The long version of FET does not increase the risk of SCI in patients with acute type A aortic dissection. The application of long FET can achieve better results in terms of remodeling of the thoracic aorta in the short‐ and medium‐term follow‐up.

Aortic remodeling, distal stent‐graft induced new entry and endoleak following frozen elephant trunk: A systematic review and meta‐analysis

“…A total of 79,931 records were collected via online database review, out of which 7345 studies were eligible for abstract screening. After applying the exclusion criteria, 109 records were adopted for full‐text screening, and eventually, reported data of 43 studies including 5068 patients who underwent TAR with FET were reviewed 4,15–56 (Figure 1).…”

Longer stent graft in frozen elephant trunk procedure: A fear or truth?

“…A recent metanalysis showed that the pooled prevalence of paraplegia was 3.5% 2 . Wang et al 3 reported an incidence of SCD of 4.4% in 158 patients with ATAAD. They have implanted longer (150 mm) Cronus hybrid prosthesis (HP) in patients who are taller than 160 cm and they found there was no statistical difference between the long and short (100 mm) HP in regards to SCD.…”

“…The average height of the Asian male (166–174 cm) is approximately 7–8 cm shorter than the European population (179–182 cm) 5 . Wang et al 3 have used 150 mm Cronus HP in 45 patients with height great than 160 cm tall and reported SCD in one patient (2.2%). Theoretically, this is equivalent to using 150 mm HP in average European men who are 180 cm tall.…”