Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Eur J Cardiothorac Surg. 2017 Oct 1;52(4):725-732. doi: 10.1093/ejcts/ezx199.
Our goal was to compare the results and outcomes of second-stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease.
Between August 2001 and December 2014, 53 patients [mean age 61 ± 13 years, 64% (n = 34) male] underwent a second-stage completion procedure. Of these patients, 32% (n = 17) had a previous ET procedure and 68% (n = 36) a previous FET procedure as a first-stage procedure.
The median times to the second-stage procedure were 7 (0-78) months in the ET group and 8 (0-66) months in the FET group. The second-stage procedure included thoracic endovascular aortic repair in 53% (n = 28) of patients and open surgical repair in 47% (n = 25). More endovascular interventions were performed in FET patients (61%, n = 22) than in the ET group (35%, n = 6, P = 0.117). The in-hospital mortality rate was significantly lower in the FET (8%, n = 3) group compared with the ET group (29%, n = 5, P = 0.045). The median follow-up time after the second-stage operation for the entire cohort was 4.6 (0.4-10.4) years. The 5-year survival rate was 76% in the ET patients versus 89% in the FET patients (log-rank: P = 0.11).
We observed a significantly lower in-hospital mortality rate in the FET group compared to the ET group. This result might be explained by the higher rate of endovascular completion in the FET group. We assume that the FET procedure offers the benefit of a more ideal landing zone, thus facilitating endovascular completion.
比较先前接受过象鼻手术（ET）或冷冻象鼻手术（FET）治疗复杂主动脉弓和降主动脉疾病的患者进行二期完成的结果和结局。
2001 年 8 月至 2014 年 12 月，53 例患者（平均年龄 61±13 岁，64%（n=34）为男性）接受了二期完成手术。这些患者中，32%（n=17）先前接受过 ET 手术，68%（n=36）先前接受过 FET 手术作为一期手术。
ET 组二期手术的中位时间为 7（0-78）个月，FET 组为 8（0-66）个月。二期手术包括 53%（n=28）患者的胸主动脉腔内修复术和 47%（n=25）患者的开放手术修复术。FET 患者的血管内介入治疗更多（61%，n=22），而 ET 组（35%，n=6，P=0.117）。FET 组（8%，n=3）的院内死亡率明显低于 ET 组（29%，n=5，P=0.045）。整个队列二期手术后的中位随访时间为 4.6（0.4-10.4）年。ET 患者的 5 年生存率为 76%，而 FET 患者为 89%（对数秩：P=0.11）。
与 ET 组相比，FET 组的院内死亡率明显较低。这一结果可能是由于 FET 组血管内完成率较高所致。我们假设 FET 手术提供了更理想的着陆区的优势，从而促进了血管内完成。
