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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| Vydáno v: | World journal of surgery Ročník 44; číslo 5; s. 1648 - 1657 |
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| Hlavní autoři: | , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
Cham
Springer International Publishing
01.05.2020
John Wiley & Sons, Inc |
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| ISSN: | 0364-2313, 1432-2323, 1432-2323 |
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| Abstract | 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. |
|---|---|
| AbstractList | ObjectivesThe aim was to evaluate the impact of a modified frozen elephant trunk procedure (mFET) on remodeling of the downstream aorta following acute aortic dissections.MethodsOver 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).ResultsMean 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 (Δr + 2.90 ± 3.64 mm) and in iAoA it increased from 31.8 ± 4.9 to 34.6 ± 5.9 mm (Δr + 2.88 ± 4.18 mm).ConclusionThe 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. 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. 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). 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 (Δr + 2.90 ± 3.64 mm) and in iAoA it increased from 31.8 ± 4.9 to 34.6 ± 5.9 mm (Δr + 2.88 ± 4.18 mm). 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. 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.OBJECTIVESThe aim was to evaluate the impact of a modified frozen elephant trunk procedure (mFET) on remodeling of the downstream aorta following acute aortic dissections.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).METHODSOver 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).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 (Δr + 2.90 ± 3.64 mm) and in iAoA it increased from 31.8 ± 4.9 to 34.6 ± 5.9 mm (Δr + 2.88 ± 4.18 mm).RESULTSMean 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 (Δr + 2.90 ± 3.64 mm) and in iAoA it increased from 31.8 ± 4.9 to 34.6 ± 5.9 mm (Δr + 2.88 ± 4.18 mm).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.CONCLUSIONThe 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. 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 (Δr + 2.90 ± 3.64 mm) and in iAoA it increased from 31.8 ± 4.9 to 34.6 ± 5.9 mm (Δr + 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. 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. |
| Author | Macius, Evelina Gahl, Brigitta Schurr, Ulrich Kaufmann, Josefin Sommer, Gregor Reuthebuch, Oliver Berdajs, Denis A. Eckstein, Friedrich Koechlin, Luca Bremerich, Jens Grapow, Martin |
| Author_xml | – sequence: 1 givenname: Luca surname: Koechlin fullname: Koechlin, Luca organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 2 givenname: Josefin surname: Kaufmann fullname: Kaufmann, Josefin organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 3 givenname: Evelina surname: Macius fullname: Macius, Evelina organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 4 givenname: Jens surname: Bremerich fullname: Bremerich, Jens organization: Department of Radiology, University Hospital Basel – sequence: 5 givenname: Gregor surname: Sommer fullname: Sommer, Gregor organization: Department of Radiology, University Hospital Basel – sequence: 6 givenname: Brigitta surname: Gahl fullname: Gahl, Brigitta organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 7 givenname: Ulrich surname: Schurr fullname: Schurr, Ulrich organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 8 givenname: Martin surname: Grapow fullname: Grapow, Martin organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 9 givenname: Oliver surname: Reuthebuch fullname: Reuthebuch, Oliver organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 10 givenname: Friedrich surname: Eckstein fullname: Eckstein, Friedrich organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 11 givenname: Denis A. surname: Berdajs fullname: Berdajs, Denis A. email: denis.berdajs@bluewin.ch organization: Department of Cardiac Surgery, University Hospital Basel |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31933041$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1177_0300060520986710 crossref_primary_10_1161_JAHA_124_034496 crossref_primary_10_23736_S0021_9509_22_12292_5 crossref_primary_10_1111_jocs_16001 crossref_primary_10_1111_jocs_15452 crossref_primary_10_3390_jcm12175693 crossref_primary_10_1093_ejcts_ezae176 |
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| Copyright | Société Internationale de Chirurgie 2020 2020 The Author(s) under exclusive licence to Société Internationale de Chirurgie Société Internationale de Chirurgie 2020. |
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| Notes | 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 |
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| References | Hiratzka, Bakris, Beckman, Bersin, Carr, Casey (CR1) 2010; 55 Lenos, Bougioukakis, Irimie, Zacher, Diegeler, Urbanski (CR2) 2015; 48 Di Bartolomeo, Di Marco, Armaro, Marsilli, Leone, Pilato, Pacini (CR6) 2009; 35 Roselli, Loor, He, Rafael, Rajeswaran, Houghtaling (CR5) 2015; 149 Tsagakis, Pacini, Di Bartolomeo, Benedik, Cerny, Gorlitzer (CR7) 2011; 39 Sakaguchi, Komiya, Tamura, Kimura, Kobayashi, Nakamura (CR14) 2007; 6 Rylski, Hahn, Beyersdorf, Kondov, Wolkewitz, Blanke (CR19) 2017; 51 Hussain, Svensson (CR10) 2016; 5 Song, Kim, Kim, Kim, Kang, Seo (CR12) 2007; 50 Roselli, Rafael, Soltesz, Canale, Lytle (CR8) 2013; 145 Asai, Suzuki, Kinoshita, Sakakura, Minamidate, Vigers (CR11) 2016; 5 Berdajs, Mosbahi, Ferrari, Charbonnier, von Segesser (CR16) 2017; 104 Pochettino, Brinkman, Moeller, Szeto, Moser, Cornelius (CR4) 2009; 88 Rylski, Hoffmann, Beyersdorf, Suedkamp, Siepe, Nitsch, Blettner, Borger, Weigang (CR3) 2014; 259 Roselli, Idrees, Bakaeen, Tong, Soltesz, Mick, Johnston, Eagleton, Menon, Svensson (CR9) 2018; 105 Kim, Lee, Lee, Jung, Choo, Lee (CR13) 2012; 42 Schoder, Czerny, Cejna, Rand, Stadler, Sodeck (CR17) 2007; 83 Murzi, Tiwari, Farneti, Glauber (CR18) 2010; 11 Immer, Hagen, Berdat, Eckstein, Carrel (CR15) 2005; 27 2017; 51 2010; 55 2009; 88 2016; 5 2010; 11 2015; 48 2014; 259 2009; 35 2015; 149 2018; 105 2013; 145 2007; 6 2007; 50 2007; 83 2011; 39 2005; 27 2017; 104 2012; 42 e_1_2_6_10_1 e_1_2_6_20_1 e_1_2_6_9_1 e_1_2_6_8_1 e_1_2_6_19_1 e_1_2_6_5_1 e_1_2_6_4_1 e_1_2_6_7_1 e_1_2_6_6_1 e_1_2_6_13_1 e_1_2_6_14_1 e_1_2_6_3_1 e_1_2_6_11_1 e_1_2_6_2_1 e_1_2_6_12_1 e_1_2_6_17_1 e_1_2_6_18_1 e_1_2_6_15_1 e_1_2_6_16_1 |
| References_xml | – volume: 259 start-page: 598 issue: 3 year: 2014 end-page: 604 ident: CR3 article-title: Acute aortic dissection type A: age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients publication-title: Ann Surg doi: 10.1097/SLA.0b013e3182902cca – volume: 145 start-page: S197 year: 2013 end-page: S201 ident: CR8 article-title: Simplified frozen elephant trunk repair for acute DeBakey type I dissection publication-title: J Thorac Cardiovasc Surg. doi: 10.1016/j.jtcvs.2012.11.068 – volume: 104 start-page: 1340 issue: 4 year: 2017 end-page: 1348 ident: CR16 article-title: Aortic valve pathology as a predictive factor for acute aortic dissection publication-title: Ann Thorac Surg doi: 10.1016/j.athoracsur.2017.02.076 – volume: 51 start-page: 1127 year: 2017 end-page: 1134 ident: CR19 article-title: Fate of the dissected aortic arch after ascending replacement in type A aortic dissection 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e_1_2_6_12_1 doi: 10.21037/acs.2016.07.02 – ident: e_1_2_6_5_1 doi: 10.1016/j.athoracsur.2009.04.046 – ident: e_1_2_6_7_1 doi: 10.1016/j.ejcts.2008.12.010 |
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The aim was to evaluate the impact of a modified frozen elephant trunk procedure (mFET) on remodeling of the downstream aorta following acute aortic... The aim was to evaluate the impact of a modified frozen elephant trunk procedure (mFET) on remodeling of the downstream aorta following acute aortic... ObjectivesThe aim was to evaluate the impact of a modified frozen elephant trunk procedure (mFET) on remodeling of the downstream aorta following acute aortic... |
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| SubjectTerms | 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 |
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| Title | Impact of Modified Frozen Elephant Trunk Procedure on Downstream Aorta Remodeling in Acute Aortic Dissection: CT Scan Follow-Up |
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