[Mid- and long-term follow-up results of thoracoabdominal aortic aneurysm repair after total aortic arch replacement and frozen elephant trunk procedure].

Objectives: To investigate the outcomes of thoracoabdominal aortic aneurysm repair (TAAAR) following total arch replacement combined stented elephant trunk implantation (Sun's procedure),and to compare the differences in surgical conditions and surgical outcomes between patients with hereditary aortic disease (HAD) and those without HAD. Methods: This is a retrospective cohort study. A retrospective analysis was conducted on the data of 199 patients who underwent TAAAR following a Sun's procedure at the Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University between July 2009 and January 2024. Among them, 150 were male (75.4%), and 49 were female(24.6%), with an age of (39.3±10.9) years (range: 16 to 66 years). The patients were stratified into the HAD group (n=97) and non-HAD group (n=102). The baseline characteristics, short-term and long-term outcomes were compared between groups using Mann-Whitney U test, independent-samples t-test, χ² test, or Fisher's exact test, as appropriate. Survival analysis was conducted using the Kaplan-Meier method, and the Log-rank test was performed to compare the differences between groups. Results: The operative mortality was 6.5% (13/199) in the entire cohort. The patients in the HAD group had a higher incidence of prior cardiovascular intervention (38.1%(37/97) vs. 21.6%(22/102), χ²=6.55, P=0.011). The interval between Sun's procedure and TAAAR was shorter in the HAD group (M(IQR), 2.2(4.0) years vs. 3.1(6.9) years,Z=-1.98,P=0.048). The non-HAD group had a significantly higher age than the HAD group ((34.7±9.2) years vs. (43.7±10.6) years, t=-6.41, P<0.01). No significant differences were observed between the two groups in operative morality, incidences of postoperative spinal cord injury, renal replacement therapy, or infection (all P>0.05). Median follow-up was 4.7(5.0) years (range: 1 month to 16.2 years) in 94.6% (176/186) patients. The 8-year overall survival rates of the HAD group and the non-HAD group were 78.9% (95%CI: 63.9% to 88.2%) and 88.1% (95%CI: 75.0% to 94.5%), respectively,and the 8-year freedom from reoperation rate were 86.5% (95%CI: 72.2% to 93.7%) and 91.0% (95%CI: 79.2% to 96.3%), respectively, which showed no statistically significant differences (all P>0.05). Conclusion: TAAAR following Sun's procedure is safe and reliable, offering favorable survival rate and low reintervention rate for both TAAA patients with HAD or without HAD.