Mid-to long-term outcomes of frozen elephant trunk and total arch replacement in patients with acute type A dissection / 中华胸心血管外科杂志

ABSTRACT

Objective Continued debates exist regarding optimal surgical approach to acute type A aortic dissection (ATAAD).This study aims to report the early and mid-to long-term outcomes of frozen elephant trunk and total arch replacement (FET + TAR) technique in patients with ATAAD involving the arch and descending aorta.Methods Between April 2003 and September 2012,we performed FET + TAR (the Sun procedure) for 456 patients with ATAAD (376 males,82.5％) at mean (5.0±3.8) days from symptom onset (median 4 days,range 4 hours to 14 days).Mean age was (46 ± 10) years.Concomitant root or valve provcedures were performed in 221 patients (48.5 ％).The outcomes were compared between patients with and without root procedures and risk factors for adverse events identified using multivariate analysis.Results Operative mortality was 8.1％ (37/456).Stroke occurred in 13 eases (2.8％),spinal cord injury in 11 (2.4％),acute renal failure in 18 (3.0％) and reexploration for bleeding in 10 (2.2％).Risk factors for operative mortality were preoperative malperfusion of the brain (odds ratio,OR 7.463,P =0.002) and spinal cord (OR 45.325,P =0.003) and time (min) of cardiopulmonary bypass (OR 1.014,P ＜0.001).Follow-up was complete in 97.6％ (409/419) averaging (5.7 ±2.4) years (range 0.2-12.0).Late death occurred in 32 patients and reoperation in 23.At 5,8 and 10 years,survival 87.7％,83.1％ and 70.5％,and freedom from reoperation was 94.8％,89.3％ and 84.3％,respectively,which did not differ with root procedure and acuity.Postoperative stroke was risk factor for late death (OR 14.452,P =0.014).The time from diagnosis to surgery (days) was risk factor for reoperation (OR 1.188,P =0.024).Patients with concomitant root procedure showed a significant trend towards lower late mortality (OR 0.377,P =0.021) and increased reoperation risk (OR 2.663,P =0.037).Competing risks analysis showed that at 3,5,8 and 10 years,mortality was 2％,5％,10％ and 23％,reoperation was 3％,5％,8％ and 10％,and reoperation-free survival was 95％,90％,82％ and 67％,respectively.Conclusion In this large series of patients with ATAAD,FET + TAR has achieved lower early mortality and morbidity and favorable late survival and freedom from reoperation.A concomitant root procedure could significantly reduce long-term survival without increasing risk for operative mortality.