Long-term outcomes in total arch replacement combined with frozen elephant trunk for acute type A aortic dissection

Kai Zhang; Juntao Qiu; Jinlin Wu; Chenyu Zhou; Yumeng Ji; Enzehua Xie; Shiqi Gao; Bin Hou; Han Li; Qian Chang; Xiangyang Qian; Xiaogang Sun; Cuntao Yu

doi:10.1016/j.jtcvs.2024.11.025

Long-term outcomes in total arch replacement combined with frozen elephant trunk for acute type A aortic dissection

J Thorac Cardiovasc Surg. 2024 Nov 26:S0022-5223(24)01106-1. doi: 10.1016/j.jtcvs.2024.11.025. Online ahead of print.

Authors

Kai Zhang¹, Juntao Qiu¹, Jinlin Wu², Chenyu Zhou¹, Yumeng Ji¹, Enzehua Xie¹, Shiqi Gao¹, Bin Hou¹, Han Li¹, Qian Chang¹, Xiangyang Qian¹, Xiaogang Sun¹, Cuntao Yu³

Affiliations

¹ Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiac Surgery, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China.
³ Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: cuntaoyu_fuwai@163.com.

PMID: 39603493
DOI: 10.1016/j.jtcvs.2024.11.025

Abstract

Objective: The optimal surgical approach for acute type A aortic dissection involving the aortic arch remains controversial. This study aims to evaluate the long-term outcomes of acute type A aortic dissection treated with total arch replacement combined with frozen elephant trunk implantation in a large single-center cohort.

Methods: From 2010 to 2022, patients with acute type A aortic dissection who received total arch replacement with frozen elephant trunk implantation at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Logistic regression and Cox regression analyses were performed to identify risk factors for operative mortality, long-term mortality, and reoperation.

Results: A total of 1672 patients underwent total arch replacement with frozen elephant trunk implantation, of whom 79.9% (1336/1672) were male with a median age of 48 years. The operative mortality rate was 6.3% (105/1672). The 10-year survival was 81.4%, and the most extended follow-up was over 13 years. Among the survivors, 89.7% (1303/1453) had complete self-care ability and were able to engage in general physical work. The 10-year cumulative incidence of reoperation was 13.3%. Multivariable logistic regression analysis revealed that male gender was associated with a reduced risk of operative death (odds ratio, 0.95, 95% CI, 0.92-0.98) and long-term death (hazard ratio, 0.68, 95% CI, 0.48-0.96).

Conclusions: Total arch replacement with frozen elephant trunk implantation demonstrates acceptable operative mortality and promising long-term outcomes for acute type A aortic dissection. Female patients face higher risks of operative and long-term mortality compared with male patients. Total arch replacement with frozen elephant trunk implantation provides patients with encouraging long-term quality of life and is advisable for acute type A aortic dissection in experienced centers.

Keywords: acute aortic dissection; aortic surgery; long-term outcomes; total arch replacement.