Safety and efficacy of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection: a propensity score-matched analysis

Abstract

Objective: To investigate the safety and efficacy of two-stage type II hybrid aortic arch repair (HAR) in elderly patients with acute type A aortic dissection (a-TAAD). Methods: This was a single-center, prospective study involved 119 patients with a-TAAD, included 82 males and 37 females, aged 22 ~81 years old. Eighty-eight patients underwent total aortic arch replacement (TAR) with stented frozen elephant trunk (FET) implantation (TAR with FET group) and 31 patients underwent two-stage type II HAR (HAR group). Propensity score matching (PSM) was applied to adjust for preoperative data, and 25 pairs were matched successfully. The preoperative, perioperative, postoperative and follow-up data in the HAR group and TAR with FET group were compared. Results: Fifteen patients died during the perioperative period; 13 cases were in the TAR with FET group and 2 cases were in the TAR group. The age, body mass index, cerebral infarction, renal insufficiency were significantly higher, and the 24-h fluid drainage, the incidence of acute liver injury, acute kidney injury and pulmonary infectionwere were lower in the HAR group. Moreover, the mechanical ventilation time, intensive care unit time, hospital stay timewere shorter in the HAR group.The follow-up period ranged from 12 to 54 months, with 7 deaths (9.3%) in the TAR with FET group and 2 deaths (6.9%) in the HAR group. The true lumen of the aortic arch (P<0.001) and the middle descending thoracic aorta were larger and the false lumen thrombosis rates of the middle descending thoracic aorta and renal artery level were higher in the HAR group. Conclusion: Two-stage type II HAR is a safe and effective method for elderly patients with a-TAAD. It may be a good choice for elderly patients with a-TAAD and comorbidities.