Impact of Modified Frozen Elephant Trunk Procedure on Downstream Aorta Remodeling in Acute Aortic Dissection: CT Scan Follow-Up

Objectives The aim was to evaluate the impact of a modified frozen elephant trunk procedure (mFET) on remodeling of the downstream aorta following acute aortic dissections. Methods Over a period of 8 years, 205 patients (mean age 62.6 ± 12.6 years) underwent a mFET ( n = 69, 33.7%) or isolated asce...

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Vydané v:	World journal of surgery Ročník 44; číslo 5; s. 1648 - 1657
Hlavní autori:	Koechlin, Luca, Kaufmann, Josefin, Macius, Evelina, Bremerich, Jens, Sommer, Gregor, Gahl, Brigitta, Schurr, Ulrich, Grapow, Martin, Reuthebuch, Oliver, Eckstein, Friedrich, Berdajs, Denis A.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Cham Springer International Publishing 01.05.2020 John Wiley & Sons, Inc
Predmet:	Abdominal Surgery Aged Aneurysms Aorta Aorta - surgery Aorta, Abdominal - diagnostic imaging Aorta, Abdominal - physiopathology Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - physiopathology Aortic Aneurysm - surgery Aortic arch Aortic dissection Blood Vessel Prosthesis Implantation Cardiac Surgery Computed tomography Coronary vessels Elephants Female Follow-Up Studies General Surgery Hospital Mortality Humans Male Medicine Medicine & Public Health Middle Aged Original Scientific Report Reoperation Retrospective Studies Surgery Survival Rate Thoracic Surgery Thorax Tomography, X-Ray Computed Vascular Remodeling Vascular Surgery
ISSN:	0364-2313, 1432-2323, 1432-2323
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Popis
Shrnutí:	Objectives The aim was to evaluate the impact of a modified frozen elephant trunk procedure (mFET) on remodeling of the downstream aorta following acute aortic dissections. Methods Over a period of 8 years, 205 patients (mean age 62.6 ± 12.6 years) underwent a mFET ( n = 69, 33.7%) or isolated ascending aorta replacement ( n = 136, 66.3%) (iAoA). Aortic diameter was assessed at the aortic arch (AoA), at the mid of the thoracic aorta (mThA), at the thoracoabdominal transition (ThAbd) and at the celiac trunk level (AbdA). Results Mean follow-up was 3.3 ± 2.6 years. In-hospital mortality was 14% ( n = 28), 7% in mFET and 17% in the iAoA group ( p = 0.08). At the end of the follow-up, overall survival was 84% (95% CI 70–92%) and 75% (65–82%) and freedom from aorta-related reoperation was 100% and 95% (88–98%) for mFET and iAoA, respectively. At iAoA, the average difference in diameter change per year between mFET and iAoA was for total lumen 0 mm (− 0.95 to 0.94 mm, p = 0.99), and for true lumen, it was 1.23 mm (− 0.09 to 2.55 mm) per year, p = 0.067. False lumen demonstrated a decrease in diameter in mFET as compared to iAoA by − 1.43 mm (− 2.75 to − 0.11 mm), p = 0.034. In mFET, at the aortic arch level the total lumen diameter decreased from 30.7 ± 4.8 mm to 30.1 ± 2.5 mm (Δ r + 2.90 ± 3.64 mm) and in iAoA it increased from 31.8 ± 4.9 to 34.6 ± 5.9 mm (Δ r + 2.88 ± 4.18 mm). Conclusion The mFET procedure provides satisfactory clinical outcome at short term and mid-term and has a positive impact on aorta remodeling, especially at the level of the aortic arch.
Bibliografia:	https://doi.org/10.1007/s00268‐020‐05374‐9 Electronic supplementary material contains supplementary material, which is available to authorized users. Luca Koechlin and Josefin Kaufmann contributed equivalently to the manuscript. The online version of this article ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0364-2313 1432-2323 1432-2323
DOI:	10.1007/s00268-020-05374-9