Strategy for acute DeBakey type I aortic dissection considering midterm results: a retrospective cohort study comparing ascending aortic replacement and total arch replacement with frozen elephant trunk technique

Acute type A aortic dissection is treated with an emergency procedure that uses ascending aortic replacement (AAR). However, to avoid a residual dissected aorta with a false lumen, total arch replacement (TAR) is required. The frozen elephant trunk (FET) technique is a promising surgical approach th...

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Bibliographic Details
Published in:Journal of cardiothoracic surgery 2024-01, Vol.19 (1), p.15-7, Article 15
Main Authors: Takagi, Sho, Goto, Yoshihiro, Yanagisawa, Junji, Ogihara, Yui, Okawa, Yasuhide
Format: Article
Language:English
Subjects:
Analysis
Aorta
Aortic dissection
Aortic Dissection - surgery
Ascending aortic replacement
Blood Vessel Prosthesis Implantation
Consciousness
Coronary artery bypass
Coronary vessels
Dissecting aneurysm
Dissection
Elephants
Emergency procedures
Frozen elephant trunk technique
Health aspects
Hospitals
Humans
Japan
Medical imaging
Methods
Mortality
Paralysis
Patients
Pulmonary arteries
Replantation
Retrospective Studies
Surgery
Tomography
Total arch replacement
Veins & arteries
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Summary:Acute type A aortic dissection is treated with an emergency procedure that uses ascending aortic replacement (AAR). However, to avoid a residual dissected aorta with a false lumen, total arch replacement (TAR) is required. The frozen elephant trunk (FET) technique is a promising surgical approach that promotes false lumen obliteration in a single step. Therefore, this retrospective single-center study aimed to evaluate the operative outcomes of AAR and TAR with FET. Between 2007 and 2021, 143 patients with acute DeBakey type I aortic dissection underwent a central repair using AAR (n = 95) or TAR with FET (n = 43). All perioperative variables, the duration of all-cause mortality, and aortic events defined as dilatation of the distal aorta > 5 cm, new occurrences of aortic dissection, distal aortic surgery, and distal aortic rupture were recorded. We compared these perioperative variables and mid-term results with an additional focus on distal aortic events. Patient background data did not differ between the two groups. Perioperative results for the TAR with FET group vs the AAR group showed similar operative times (306 vs 298 min, P = 0.862), but the TAR group had longer cardiopulmonary bypass times (154 vs 179 min, P 
ISSN:1749-8090
1749-8090
DOI:10.1186/s13019-024-02484-6