The Journal of thoracic and cardiovascular surgery · 2025
Acute type A dissection with iliofemoral or renal malperfusion: Is frozen elephant trunk necessary?
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Nissen Alexander P, Reul Ross Michael, Naeem Muhammad, Zurcher Jonathan R, Farrington Woodrow J, Keeling William Brent, Leshnower Bradley G
Аннотация
BACKGROUND: Frozen elephant trunk (FET) is being increasingly used for acute type A aortic dissection (ATAAD) with distal malperfusion. The efficacy of adding a stent graft remains unclear, however. This study investigated the efficacy of adding FET to conventional arch repair when treating ATAAD with iliofemoral or renal malperfusion.
METHODS: A review of the Emory Aortic Database identified 969 patients with acute DeBakey 1 dissection from 2004 to February 2025. One hundred fifty-three patients with iliofemoral and/or renal malperfusion underwent emergent central aortic repair alone (conventional group; n = 102) or central repair plus FET (FET group; n = 51). Univariate statistics were used to compare the 2 groups. Multivariable logistic regression was used to examine factors associated with postoperative limb revascularization and new renal failure. Selection bias was addressed through inverse-probability treatment weighting adjustment.
RESULTS: Age and preoperative comorbidities were equivalent in the 2 groups. Limb ischemia requiring revascularization (17.6% for conventional vs 15.7% for FET; P = .856), or new dialysis (21.6% for conventional vs 17.6% for FET; P = .547) also was similar between the groups. Multivariable regression did not identify FET as independently associated with a reduced need for limb revascularization in iliofemoral malperfusion patients (odds ratio [OR], 1.334; 95% confidence interval [CI], 0.434-4.098; P = .614) or with avoiding dialysis in renal malperfusion patients (OR, 1.166; 95% CI, 0.252-5.382; P = .844). Mid-term survival (71.1% for conventional 71.1% vs 75.5% for FET; log-rank P = .753) and distal reintervention-free survival (64.9% for conventional vs 69.4% for FET; log-rank P = .902) were equivalent.
CONCLUSIONS: The addition of FET to conventional repair did not impact limb revascularization, new dialysis, or mid-term reintervention or improve mid-term survival in ATAAD with iliofemoral or renal malperfusion.
METHODS: A review of the Emory Aortic Database identified 969 patients with acute DeBakey 1 dissection from 2004 to February 2025. One hundred fifty-three patients with iliofemoral and/or renal malperfusion underwent emergent central aortic repair alone (conventional group; n = 102) or central repair plus FET (FET group; n = 51). Univariate statistics were used to compare the 2 groups. Multivariable logistic regression was used to examine factors associated with postoperative limb revascularization and new renal failure. Selection bias was addressed through inverse-probability treatment weighting adjustment.
RESULTS: Age and preoperative comorbidities were equivalent in the 2 groups. Limb ischemia requiring revascularization (17.6% for conventional vs 15.7% for FET; P = .856), or new dialysis (21.6% for conventional vs 17.6% for FET; P = .547) also was similar between the groups. Multivariable regression did not identify FET as independently associated with a reduced need for limb revascularization in iliofemoral malperfusion patients (odds ratio [OR], 1.334; 95% confidence interval [CI], 0.434-4.098; P = .614) or with avoiding dialysis in renal malperfusion patients (OR, 1.166; 95% CI, 0.252-5.382; P = .844). Mid-term survival (71.1% for conventional 71.1% vs 75.5% for FET; log-rank P = .753) and distal reintervention-free survival (64.9% for conventional vs 69.4% for FET; log-rank P = .902) were equivalent.
CONCLUSIONS: The addition of FET to conventional repair did not impact limb revascularization, new dialysis, or mid-term reintervention or improve mid-term survival in ATAAD with iliofemoral or renal malperfusion.
Предметные рубрики MeSH
HumansFemaleMaleMiddle AgedAortic DissectionRetrospective StudiesAgedBlood Vessel Prosthesis ImplantationTreatment OutcomeFemoral ArteryIliac ArteryRisk FactorsIschemiaEndovascular ProceduresBlood Vessel ProsthesisDatabases, FactualStentsKidneyPostoperative ComplicationsRenal CirculationAortic Aneurysm, Thoracic