The Journal of thoracic and cardiovascular surgery · 2019
Aortic reinterventions after the frozen elephant trunk procedure.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Kreibich Maximilian, Berger Tim, Rylski Bartosz, Chen Zehang, Beyersdorf Friedhelm, Siepe Matthias, Czerny Martin
Аннотация
OBJECTIVE: The frozen elephant trunk (FET) procedure has emerged as a potential single-step treatment for pathologies of the thoracic aorta, but the procedure's true potential to be a single-step treatment remains unclear. The aim of this study was to evaluate the need and outcomes of aortic reinterventions after previous FET implantation.
METHODS: Patient characteristics and follow-up data of 107 patients following the FET procedure were evaluated and compared between patients with and without aortic reinterventions. A competing risk regression model was analyzed to identify independent predictors of aortic reintervention and to predict the risk for reintervention.
RESULTS: Intended completion, anticipated reinterventions, and unexpected reinterventions were performed in 35 patients (33%). There was no difference in the underlying pathology between patients with or without aortic reintervention. An endovascular reintervention was performed in 24 patients (69%), open surgery in 7 patients (20%) and a hybrid approach in 4 patients (11%). No stroke or permanent spinal cord injuries were observed. In-hospital mortality after reintervention was 14% (5 patients), but there was no difference in survival during follow-up after FET implantation (log rank test, P = .58). No risk factors for aortic reinterventions were identified. The risk for aortic reintervention was 31% (95% confidence interval [CI], 21%-42%), 49% (95% CI, 35%-62%), and 64% (95% CI, 44%-79%) after 12, 24, and 36 months, respectively.
CONCLUSIONS: Aortic reinterventions are common and likely after FET implantation, but this study did not identify independent predictors. Reinterventions are associated with acceptable morbidity and mortality. Close follow-up of all patients undergoing FET procedure is paramount.
METHODS: Patient characteristics and follow-up data of 107 patients following the FET procedure were evaluated and compared between patients with and without aortic reinterventions. A competing risk regression model was analyzed to identify independent predictors of aortic reintervention and to predict the risk for reintervention.
RESULTS: Intended completion, anticipated reinterventions, and unexpected reinterventions were performed in 35 patients (33%). There was no difference in the underlying pathology between patients with or without aortic reintervention. An endovascular reintervention was performed in 24 patients (69%), open surgery in 7 patients (20%) and a hybrid approach in 4 patients (11%). No stroke or permanent spinal cord injuries were observed. In-hospital mortality after reintervention was 14% (5 patients), but there was no difference in survival during follow-up after FET implantation (log rank test, P = .58). No risk factors for aortic reinterventions were identified. The risk for aortic reintervention was 31% (95% confidence interval [CI], 21%-42%), 49% (95% CI, 35%-62%), and 64% (95% CI, 44%-79%) after 12, 24, and 36 months, respectively.
CONCLUSIONS: Aortic reinterventions are common and likely after FET implantation, but this study did not identify independent predictors. Reinterventions are associated with acceptable morbidity and mortality. Close follow-up of all patients undergoing FET procedure is paramount.