Liakopoulos Oliver J, Kroener Axel, Sabashnikov Anton, Zeriouh Mohamed, Ahmad Wael, Choi Yeong-Hoon, Wahlers Thorsten
Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany.
Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Campus Kerckhoff, University of Giessen, Hessen, Germany.
J Thorac Dis. 2020 Oct;12(10):5387-5397. doi: 10.21037/jtd-20-1531.
The frozen elephant trunk (FET) technique is increasingly used for the treatment of acute and chronic aortic arch disease. This study reports our single center experience with the FET technique in patients with complex aortic disease.
Between 2009 and 2019, 111 consecutive patients underwent aortic arch surgery in our institution using the FET technique for acute type A dissection (AAD group; n=75) or non-acute type A dissection (non-AAD group; n=36; 10 patients with chronic type A dissection; 26 patients with aneurysm), respectively. Relevant perioperative data, including 30-day mortality and neurological complications, were retrospectively obtained from our electronic patient's records, including follow-up (FU) data of outpatient clinical visits and computed tomography (CT).
Thirty-day mortality in the entire FET cohort was 16.2% (AAD 18.7% non-AAD 11.1%; n=0.414). Severe brain injury was the leading cause of death in AAD patients (12.0% . 0% non-AAD; P=0.030). Overall permanent stroke and spinal cord injury was 12.6% and 3.6%. Four patients in the AAD group developed paraplegia and permanent stroke rate was significantly higher in AAD compared to non-AAD patients (17.3% 2.8%; P=0.034). One, 3- and 5-year survival rates were 78.7%±4.0%, 72.2%±4.8%, and 64.3%±6.8% for the total cohort; survival at 1-, 3- and 5-year was 76.7%±5.0%, 71.0%±6.1%, and 64.5%±8.3% for the AAD cohort compared to 83.1%±6.3%, 75.0%±7.9% and 66.7% for non-AAD patients (P=0.579), respectively.
Our single-center experience confirms good early and mid-term survival after the FET procedure in patients presenting with AAD, CAD and aneurysm. Future efforts should focus on reduction of severe neurological complication.
冷冻象鼻技术（FET）越来越多地用于治疗急慢性主动脉弓疾病。本研究报告了我们在复杂主动脉疾病患者中应用FET技术的单中心经验。
2009年至2019年期间，我们机构连续111例患者接受了主动脉弓手术，使用FET技术治疗急性A型主动脉夹层（AAD组；n = 75）或非急性A型主动脉夹层（非AAD组；n = 36；10例慢性A型主动脉夹层患者；26例动脉瘤患者）。从我们的电子患者记录中回顾性获取相关围手术期数据，包括30天死亡率和神经系统并发症，包括门诊临床就诊和计算机断层扫描（CT）的随访（FU）数据。
整个FET队列的30天死亡率为16.2%（AAD组18.7%，非AAD组11.1%；n = 0.414）。严重脑损伤是AAD患者的主要死亡原因（12.0%，非AAD组为0%；P = 0.030）。总体永久性卒中及脊髓损伤发生率分别为12.6%和3.6%。AAD组有4例患者发生截瘫，AAD组永久性卒中发生率显著高于非AAD组患者（17.3%对2.8%；P = 0.034）。整个队列的1年、3年和5年生存率分别为78.7%±4.0%、72.2%±4.8%和64.3%±6.8%；AAD队列的1年、3年和5年生存率分别为76.7%±5.0%、71.0%±6.1%和64.5%±8.3%，而非AAD患者分别为83.1%±6.3%、75.0%±7.9%和66.7%（P = 0.579）。
我们的单中心经验证实，对于患有AAD、CAD和动脉瘤的患者，FET手术后早期和中期生存率良好。未来的努力应集中在减少严重神经系统并发症上。
