Impact of the frozen elephant trunk technique in operation for acute type A aortic dissection: from the Japan cardiovascular surgery database.

OBJECTIVES

We compared early outcomes of total arch repair (TAR) and ascending aorta replacement (AAR) for acute aortic dissection type A (AADA) using the nationwide Japan Cardiovascular Surgery Database (JCVSD) and examined the role of the frozen elephant trunk (FET) technique in TAR.

METHODS

Of 17,075 JCVSD patients undergoing urgent or emergent conventional surgery for AADA in 2013-2016, redo cases and those undergoing valve/root or coronary surgery were excluded (included n = 12,288). Four propensity score-matched analyses for treatment with AAR or TAR (n = 4272 each) were established.

RESULTS

After matching, procedure times were significantly longer and incidences of re-exploration for bleeding (5.9 vs. 3.9%, P < 0.0001) or spinal cord injury (4.8 vs. 3.3%, P = 0.0003) were significantly higher in the TAR group than AAR group. In-hospital mortality rate was significantly higher in the TAR group than AAR group (9.5 vs. 7.0%, P < 0.0001). When FET was used, the incidences of some of morbidities improved and the difference in in-hospital mortality between TAR and AAR groups disappeared (8.3 vs. 7.7%, P = 0.6583). However, the incidence of re-exploration for bleeding was still high (5.7 vs. 3.0%, P = 0.0066) and the incidence of spinal cord injury became pronounced (6.7 vs. 2.9%, P = 0.0002).

CONCLUSIONS

TAR was associated with longer procedure time and higher incidences of postoperative morbidities and mortality. FET holds promise for improving outcomes of TAR. However, spinal cord injury has emerged as another serious concern and its clinical role remains unclear.