Hybrid type II and frozen elephant trunk in acute Stanford type A aortic dissections

Sule, Jai Ajitchandra; Chua, Cher Rui; Teo, Caven; Choong, Andrew M.T.L.; Sazzad, Faizus; Kofidis, Theo; Sorokin, Vitaly

doi:10.1080/14017431.2022.2074095

Cited by 6 publications

(4 citation statements)

References 47 publications

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“…A recent meta-analysis of 1305 patients from 11 studies compared the results of type II HAR and TAR with FET. They found that type II HAR was associated with reduced early mortality, stroke, spinal cord injury, renal impairment requiring dialysis and reoperation for bleeding and lung infection, verified the safety of type II HAR 22 . However, all studies used one-stage HAR, which is performed in hybrid operating rooms; however, most medical facilities in developing countries lack hybrid operating rooms.…”

Section: Discussionmentioning

confidence: 83%

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: Discussionmentioning

confidence: 83%

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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“…At our institution, patients with acute DeBakey type I aortic dissection are operated on at the earliest opportunity. The methods used include surgical and hybrid therapies ( 17 , 18 ), including surgery of the aortic root, ascending aorta, and aortic arch. Patients with aortic dissection limited to the ascending aorta (without involvement of the aortic arch, DeBakey type II) and patients undergoing a hybrid procedure are in small proportions at our center.…”

Section: Discussionmentioning

confidence: 99%

FL% is associated with the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk and total arch replacement

Wang,

Li,

Jin

et al. 2024

Front. Surg.

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ObjectivesThe diameter, area, and volume of the true lumen and false lumen (FL) have been measured in previous studies to evaluate the extent of DeBakey type I aortic dissection. However, these indicators have limitations because of the irregular shapes of the true and false lumens and the constant oscillation of intimal flap during systole and diastole. The ratio of arch lengths seems to be a more reliable indicator. FL% was defined as the ratio of the arch length of FL to the circumference of the aorta at the different levels of the aorta. The purpose of this article was to investigate whether FL% is a predictor of the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk (FET) and total arch replacement.MethodsIn this retrospective observational study, we analyzed a total of 344 patients with acute DeBakey type I aortic dissection that underwent FET and total arch replacement at our center from October 2015 to October 2019. The patients were divided into two groups by cluster analysis according to the perioperative course. Binary logistic regression analyses were performed to determine whether FL% could predict the severity of acute DeBakey type I aortic dissection. The area under the receiver operating characteristic curve (AUROC) was used to assess the power of the multivariate logistic regression model for the severity of acute DeBakey type I aortic dissection.ResultsThe patients in the ultra-high-risk group (109 patients) had significantly more severe clinical comorbidities and complications than the patients in the high-risk group (235 patients). The ascending aortic FL% [odds ratio (OR), 11.929 (95% CI: 1.421–100.11); P = 0.022], location of initial tear [OR, 0.68 (95% CI: 0.47–0.98); P = 0.041], the degree of left iliac artery involvement [OR, 1.95 (95% CI: 1.15–3.30); P = 0.013], and the degree of right coronary artery involvement [OR, 1.46 (95% CI: 1.01–2.12); P = 0.045] on preoperative computed tomography angiography were associated with the severity of acute DeBakey type I aortic dissection. The AUROC value of this multivariate logistic regression analysis was 0.940 (95% CI: 0.914–0.967; P < 0.001). The AUROC value of ascending aortic FL% was 0.841 (95% CI: 0.798–0.884; P < 0.001) for the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement.ConclusionsAscending aortic FL% was validated as an essential radiologic index for assessing the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement. Higher values of ascending aortic FL% were more severe.

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“…Recently, the HAR technique has been widely employed in the treatment of a-TAAD, and achieved good short-and mediumterm results (8-10). A recent meta-analysis included 1305 cases from 11 studies to compare the results of type II HAR and TAR with FET, and the results showed that type II HAR was associated with reduced early mortality, stroke, spinal cord injury, renal impairment requiring dialysis and reoperation for bleeding and lung infection, veri ed the safety of type II HAR (22). However, all studies used one-stage HAR, which is performed in hybrid operating rooms; however, most medical facilities in developing countries lack hybrid operating rooms.…”

Section: Discussionmentioning

confidence: 99%

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

Xiang

Pen

et al. 2023

Preprint

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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.

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Hybrid type II and frozen elephant trunk in acute Stanford type A aortic dissections

Cited by 6 publications

References 47 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

FL% is associated with the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk and total arch replacement

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

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