Concomitant Aortic Root Replacement in Total Arch Replacement With Frozen Elephant Trunk for Type A Aortic Dissection: A Propensity-Weighted Analysis.

OBJECTIVES

This study aims to evaluate the impact of concomitant aortic root replacement (ARR) on early and late outcomes in patients undergoing total arch replacement (TAR) with frozen elephant trunk (FET) for type A aortic dissection (TAAD).

METHODS

From January 2010 to December 2019, a total of 1155 patients were enrolled. Among them, 325 patients received concomitant ARR (with ARR group) while 830 patients did not (without ARR group). Baseline differences were adjusted using inverse probability of treatment weighting (IPTW).

RESULTS

After IPTW, the with ARR group still had a higher prevalence of Marfan syndrome (2.6% vs 7.3%, P = .038) and a greater proportion of patients with moderate or greater aortic insufficiency (18.1% vs 64.7%, P < .001). Cardiopulmonary bypass (CPB) time and aortic cross-clamp time were significantly longer in with ARR group (CPB time: 180 [151-212] vs 197 [171-236] min, P < .001; cross-clamp time: 100 [83-120] vs 112 [95-135] min, P < .001). There were no significant differences in 30-day mortality and major complications. Multivariable logistic regression analysis revealed that after adjustment for age, gender, variables with potential clinical correlation with outcomes and variables with P < .1 in univariable analysis, ARR was not associated with 30-day mortality (odds ratio [OR]: 0.92, 95% CI: 0.52-1.62, P = .769). There was no significant difference in overall survival (log rank: P = .258) and proximal reintervention (log rank: P = .337) in follow-up between patients in with ARR group and without ARR group.

CONCLUSIONS

In patients undergoing TAR with FET for TAAD, concomitant ARR did not increase early and late postoperative mortality or morbidity. ARR can be safely performed concurrently with TAR and FET when anatomically indicated.