R Wilson King, Adam M Carroll, Kelly C Higa, Joseph C Cleveland, Jessica Y Rove, Muhammad Aftab, Thomas Brett Reece
{"title":"Frozen Elephant Trunk for Acute Type A Dissection: Is Risk from Procedure or Patient Characteristics?","authors":"R Wilson King, Adam M Carroll, Kelly C Higa, Joseph C Cleveland, Jessica Y Rove, Muhammad Aftab, Thomas Brett Reece","doi":"10.1055/s-0043-1768970","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong> The initial goal of acute Type A aortic dissection (ATAAD) repair remains to get the patient off the table safely. More extensive repair is being pushed at the index operation with the frozen elephant trunk (FET) operation, but outcomes are suggested to be worse. However, we hypothesize that the risk associated with the FET in ATAAD is from the patient presenting factors rather than the operation itself.</p><p><strong>Methods: </strong> A retrospective review of a single institution prospective database from 2015 to 2021 was performed. Two cohorts were created based on the indication for FET: evidence of radiographic malperfusion (<i>n</i> = 44) or clinical malperfusion (<i>n</i> = 31). Data were analyzed for preoperative characteristics, intraoperative characteristics, and postoperative outcomes. Statistical univariate analysis was performed with chi-square analysis and <i>t</i>-tests with significance determined at an alpha level of 0.05.</p><p><strong>Results: </strong> Preoperative characteristics were similar in each group, independent of malperfusion markers. The intraoperative characteristics were similar, except the clinical malperfusion group had more packed red blood cells and cryoprecipitate given. The clinical malperfusion group had longer intensive care unit length of stay (<i>p</i> < 0.001), more postoperative strokes (<i>p</i> < 0.001), more reoperations (<i>p</i> <0.0001), and higher mortality rate (<i>p</i> = 0.0003).</p><p><strong>Conclusion: </strong> These data suggest that clinical malperfusion increases the risk of major complications and death. However, full arch replacement with FET in the absence of clinical malperfusion does not appear to add risk to the operation for ATAAD. Patients with increased risk of distal degeneration should be considered for more aggressive replacement to avoid subsequent arch replacement.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/07/10-1055-s-0043-1768970.PMC10449567.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"AORTA","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/s-0043-1768970","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The initial goal of acute Type A aortic dissection (ATAAD) repair remains to get the patient off the table safely. More extensive repair is being pushed at the index operation with the frozen elephant trunk (FET) operation, but outcomes are suggested to be worse. However, we hypothesize that the risk associated with the FET in ATAAD is from the patient presenting factors rather than the operation itself.
Methods: A retrospective review of a single institution prospective database from 2015 to 2021 was performed. Two cohorts were created based on the indication for FET: evidence of radiographic malperfusion (n = 44) or clinical malperfusion (n = 31). Data were analyzed for preoperative characteristics, intraoperative characteristics, and postoperative outcomes. Statistical univariate analysis was performed with chi-square analysis and t-tests with significance determined at an alpha level of 0.05.
Results: Preoperative characteristics were similar in each group, independent of malperfusion markers. The intraoperative characteristics were similar, except the clinical malperfusion group had more packed red blood cells and cryoprecipitate given. The clinical malperfusion group had longer intensive care unit length of stay (p < 0.001), more postoperative strokes (p < 0.001), more reoperations (p <0.0001), and higher mortality rate (p = 0.0003).
Conclusion: These data suggest that clinical malperfusion increases the risk of major complications and death. However, full arch replacement with FET in the absence of clinical malperfusion does not appear to add risk to the operation for ATAAD. Patients with increased risk of distal degeneration should be considered for more aggressive replacement to avoid subsequent arch replacement.
背景:急性A型主动脉夹层(ATAAD)修复的最初目标仍然是使患者安全下床。更广泛的修复正在推进与冷冻象鼻(FET)手术的索引操作,但结果被认为更差。然而,我们假设与ATAAD中FET相关的风险来自患者的表现因素,而不是手术本身。方法:对2015年至2021年的单一机构前瞻性数据库进行回顾性分析。根据FET的适应症创建了两个队列:影像学灌注不良证据(n = 44)或临床灌注不良证据(n = 31)。对数据进行术前、术中、术后结果分析。统计单变量分析采用卡方分析和t检验,α水平为0.05,具有显著性。结果:各组术前特征相似,不受灌注不良指标影响。术中特征相似,但临床灌注不良组红细胞堆积较多,给予低温沉淀。临床灌注不良组重症监护病房住院时间更长(p p p p = 0.0003)。结论:临床灌注不良增加了主要并发症和死亡的风险。然而,在没有临床灌注不良的情况下,用FET进行全弓置换似乎不会增加ATAAD手术的风险。远端退变风险增加的患者应考虑更积极的置换术,以避免后续的弓置换术。