Comparison of two surgical approaches for acute type A aortic dissection: hybrid debranching versus total arch replacement

Huang, Feng; Li, Xiaofeng; Zhang, Zili; Li, Chunping; Ren, Fei

doi:10.1186/s13019-022-01920-9

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…The current study explored the two-stage HAR procedure for high-risk elderly a-TAAD patients based on previous studies and achieved good results. CPB, ACC, HCA, mechanical ventilation, ICU stay and hospital stay times were shorter and the complications of acute liver injury, AKI and pulmonary infection were lower in the two-stage HAR group than that in the TAR with FET group, which were consistent with previous one-stage HAR studies 8 – 10 .…”

Section: Discussionsupporting

confidence: 90%

“…HAR combines open surgical debranching with TEVAR, preventing HCA and simplifying the operation, thereby reducing mortality 21 . Recently, the HAR technique has been widely employed in the treatment of a-TAAD, and achieved good short- and medium-term results 8 – 10 . A recent meta-analysis of 1305 patients from 11 studies compared the results of type II HAR and TAR with FET.…”

Section: Discussionmentioning

confidence: 99%

“…Hybrid surgery has become a new option for the treatment of a-TAAD 7 . Some studies have reported that type II hybrid aortic arch repair (HAR) achieved good short- and medium-term effectiveness in the treatment of a-TAAD 8 – 10 . However, they all use one-stage HAR, which is performed in hybrid operating rooms; however, most medical facilities in developing countries lack hybrid operating rooms.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection

Xiang,

He,

Pen

et al. 2024

Sci Rep

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Acute type A aortic dissection (a-TAAD) is a severe disease characterized by high mortality, which can be fatal in elderly patients. The objective of this study was 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). This was a single-center, retrospective study involving 119 patients with a-TAAD, including 82 males and 37 females, aged 22–81 years old. Eighty-eight patients underwent total aortic arch replacement (TAR) with frozen elephant trunk (FET) implantation (TAR with FET group) and 31 patients underwent two-stage type II HAR (HAR group). Propensity score matching was applied to adjust for preoperative data, and match 25 pairs. The preoperative, perioperative, postoperative and follow-up data were recorded. Fifteen patients died during the perioperative period; 13 cases were in the TAR with FET group and 2 cases were in the HAR 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 infection were lower in the HAR group (all P < 0.05). Moreover, the mechanical ventilation time, intensive care unit time, hospital stay time were shorter in the HAR group (all P < 0.05). 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 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 (all P < 0.05). Two-stage type II HAR is a safe and effective method for the treatment of elderly patients with a-TAAD. It may be a good choice for elderly patients with a-TAAD and comorbidities.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection

Xiang,

He,

Pen

et al. 2024

Sci Rep

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“…The result is a significant shortening of the arrest, clamp, and operation room times with the potential for less neurological and other complications. 62 Besides the publications in 2022 that supported the concept that arch replacement potentially including elephant trunks may be an option in experienced hands with improved long-term survival, 63 other publications addressed the elevated risk of octogenarians with type A dissections 64 and the need for individual patient selection. 65 An impressive study was published from Paris and Bologna.…”

Section: Glimpse Into Surgery Of the Aorta And For Terminal Heart Fai...mentioning

confidence: 99%

Cardiac Surgery 2022 Reviewed

Doenst,

Schneider,

Caldonazo

et al. 2023

Thorac Cardiovasc Surg

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PubMed displayed almost 37,000 hits for the search term “cardiac surgery AND 2022.” As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

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“…(19,20) Hybrid EAR with a frozen elephant trunk (FET) has become a popular and promising option for patients in need of aortic arch repair. (17,21,22) Single-center studies have indicated long-term benefits of this approach without increasing perioperative risks. The evidence supports the use of hybrid EAR as a diverse and effective alternative to traditional arch replacements.…”

Section: Introductionmentioning

confidence: 99%

Aortic Arch registry of type A aortic dissection (AoArch) - rationale, design and definition criteria

Nappi,

Schoell,

Singh

et al. 2024

Preprint

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Background: Type A acute aortic dissection (TAAAD) is a deadly condition that demands immediate surgery, because it involves a patient in critical, unstable condition. The mortality and morbidity associated with it are significant, and it is vital that the patient's conditions and treatment strategies are fully understood to ensure the appropriate management of TAAAD. This study will definitively answer whether hemiarch repair (HAR) versus extended arch repair (EAR) with or without descending aortic intervention results in better perioperative and late outcomes for patients with TAAAD. Methods: Four leading centers of cardiac surgery from two European countries have joined forces to create a groundbreaking multicenter observational registry (AoArch). This registry will enroll consecutive patients who underwent surgery for TAAAD from January 2005 to March 2024. We will analyze how patient comorbidities, referral conditions, and surgical strategies involving hemiarch repair (HAR) and extended arch repair (EAR) impact early and late adverse events. We have developed a procedure urgency algorithm based on the severity of preoperative hemodynamic conditions and malperfusion due to TAAAD, and we will use it to assess the primary clinical outcomes: in-hospital mortality, late mortality, and reoperations on the aorta. We will define secondary outcomes as permanent neurologic deficit, the need for new dialysis, respiratory failure, a composite of major adverse events (myocardial infarction, cerebrovascular accidents, the need for dialysis, or the need for tracheostomy), and a composite of major adverse pulmonary events (intubation over 48 hours, pneumonia, reintubation, tracheostomy), and reoperation due to bleeding. Discussion: This multicenter registry will definitively determine the prognostic significance of critical preoperative conditions and the efficacy of extended arch interventions and hemiarch repair in reducing the risk of early adverse events after surgery for TAAAD. This registry will provide insights into the long-term durability of different strategies of surgical repair for TAAAD.

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Comparison of two surgical approaches for acute type A aortic dissection: hybrid debranching versus total arch replacement

Cited by 8 publications

References 17 publications

Outcomes of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection

Outcomes of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection

Cardiac Surgery 2022 Reviewed

Aortic Arch registry of type A aortic dissection (AoArch) - rationale, design and definition criteria

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