Mkalaluh Sabreen, Szczechowicz Marcin, Mashhour Ahmed, Zhigalov Konstantin, Easo Jerry, Eichstaedt Harald Christian, Ennker Jürgen, Thomas Rohit Philip, Chavan Ajay, Weymann Alexander
Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
Department of Radiology, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
J Thorac Dis. 2018 Nov;10(11):6192-6200. doi: 10.21037/jtd.2018.10.42.
Surgical management of aortic arch diseases is one of the most challenging issues in cardiovascular surgery. The aim of this study was to compare the outcome after frozen elephant trunk (FET) with conventional elephant trunk (ET) technique.
Out of a total of 551 patients after thoracic aortic surgery, we analyzed 70 consecutive patients, who underwent aortic arch replacement with ET or FET technique between 2001 and 2017 in our institution. The patients were case-control matched in regard to such variables as age, sex, presence of an acute aortic dissection and necessity for concomitant procedures. The analysis included 25 patient pairs.
Among the 25 FET patients, eleven patients were female, the median age was 69, 15 (60%) patients had an aortic dissection and thirteen needed various concomitant procedures. In the second group, treated with conventional ET technique, 10 (40%) patients were female, the median age was 66 years, thirteen presented with an aortic dissection and 16 (64%) underwent concomitant procedures. These and other characteristics did not differ significantly between the groups. In-hospital mortality was statistically similar: 5 (20%) in the FET group 8 (32%) for ET group (P=0.52). The incidence of stroke, acute renal failure and postoperative bleeding was comparable. The length of stay in the intensive care unit did not differ between the cohorts (P=0.258). Predictors of in-hospital mortality were length of the operation, bleeding postoperatively, and acute renal failure. The one-year survival rates were higher in the FET cohort compared to the conventional approach (60% 38%), however without statistical significance.
In regard to the short- and mid-term outcome, there were only slight differences between both techniques. In patients with extensive aneurysmal aortic disease, conventional ET and FET procedures seem to be associated with acceptable satisfactory mid-term outcome.
主动脉弓疾病的外科治疗是心血管外科中最具挑战性的问题之一。本研究的目的是比较采用冰冻象鼻术（FET）与传统象鼻术（ET）后的治疗效果。
在总共551例胸主动脉手术后的患者中，我们分析了2001年至2017年期间在我们机构接受ET或FET技术进行主动脉弓置换的70例连续患者。患者在年龄、性别、急性主动脉夹层的存在以及是否需要同期手术等变量方面进行病例对照匹配。分析包括25对患者。
在25例接受FET治疗的患者中，11例为女性，中位年龄为69岁，15例（60%）患者有主动脉夹层，13例需要进行各种同期手术。在采用传统ET技术治疗的第二组中，10例（40%）为女性，中位年龄为66岁，13例有主动脉夹层，16例（64%）接受了同期手术。这些以及其他特征在两组之间没有显著差异。住院死亡率在统计学上相似：FET组为5例（20%），ET组为8例（32%）（P=0.52）。中风、急性肾衰竭和术后出血的发生率相当。重症监护病房的住院时间在两组之间没有差异（P=0.258）。住院死亡率的预测因素是手术时间、术后出血和急性肾衰竭。与传统方法相比，FET组的一年生存率更高（60%对38%），但无统计学意义。
就短期和中期结果而言，两种技术之间只有细微差异。在患有广泛动脉瘤性主动脉疾病的患者中，传统ET和FET手术似乎都与可接受的满意中期结果相关。
