Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russia.
Interact Cardiovasc Thorac Surg. 2021 Jul 26;33(2):286-292. doi: 10.1093/icvts/ivab086.
The objective of the study was to evaluate early and midterm outcomes after the frozen elephant trunk (FET) procedure with different proximal landing zones in patients with aortic dissection.
Forty-four patients with type A and type B aortic dissection that extended down to the abdominal aorta were enrolled in the study. All of the patients had the FET procedure. The patients were divided in 2 groups according to the level of the proximal landing zone: the zone 2 (Z2) group and zone 3 (Z3) group. Early and midterm outcomes including the false lumen (FL) thrombosis rate were monitored in both groups.
The incidence of stroke, delirium and spinal cord ischaemia was 5.9% vs 3.7% (P = 0.533), 5.9% vs 7.4% (P = 0.903) and 5.9% vs 0 (P = 0.533) in the Z2 and Z3 groups, respectively. The 30-day mortality was 9.1% in both groups. The mean distal landing zone was T7.5 (T7; T9) in the Z2 group vs T9 (T8; T10) in the Z3 group (P = 0.668). The 2-year overall survival was 62.2% with no significant difference in the Z2 and Z3 groups (61.6% vs 64.2%; P = 0.940). There were no aortic-related deaths during the follow-up period. Freedom from reintervention at 24 months was 73% and was comparable between Z2 and Z3 (74.1% vs 91.7%; P = 0.123). The rate of early complete FL thrombosis was comparable in the Z2 and Z3 groups. By 24 months of observation in the Z3 group, the rate of complete FL thrombosis was significantly higher (60% vs 77%; P = 0.046).
No statistically significant differences were observed between landing zones 2 and 3 during the FET procedure with regard to early outcomes. Proximalization of the FET was associated with a shorter FL thrombosis in the midterm follow-up period that affected the distal aortic reintervention rate.
本研究旨在评估不同近端着陆区在主动脉夹层患者中行冰冻象鼻手术（FET）的早期和中期结果。
本研究纳入了 44 例累及降主动脉的 A 型和 B 型主动脉夹层患者。所有患者均接受 FET 手术。根据近端着陆区水平将患者分为 2 组：Z2 组和 Z3 组。监测两组的早期和中期结果，包括假腔（FL）血栓形成率。
Z2 组和 Z3 组的卒中、谵妄和脊髓缺血发生率分别为 5.9%比 3.7%（P=0.533）、5.9%比 7.4%（P=0.903）和 5.9%比 0（P=0.533）。两组的 30 天死亡率均为 9.1%。Z2 组的平均远端着陆区为 T7.5（T7；T9），Z3 组为 T9（T8；T10）（P=0.668）。2 年总生存率分别为 62.2%，Z2 组和 Z3 组无显著差异（61.6%比 64.2%；P=0.940）。随访期间无主动脉相关死亡。24 个月时免于再次干预的比例为 73%，Z2 组和 Z3 组相当（74.1%比 91.7%；P=0.123）。Z2 组和 Z3 组早期完全 FL 血栓形成率相当。Z3 组观察到 24 个月时完全 FL 血栓形成率明显升高（60%比 77%；P=0.046）。
在 FET 手术中，着陆区 2 和 3 之间的早期结果无统计学差异。近端化 FET 与中期随访期间 FL 血栓形成更短有关，这影响了远端主动脉再次干预的发生率。
