Berger Tim, Graap Miriam, Rylski Bartosz, Fagu Albi, Gottardi Roman, Walter Tim, Discher Philipp, Hagar Muhammad Taha, Kondov Stoyan, Czerny Martin, Kreibich Maximilian
Department of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, Germany.
Department for Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Centre-University of Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Front Cardiovasc Med. 2022 Jun 6;9:911548. doi: 10.3389/fcvm.2022.911548. eCollection 2022.
Aim of this study was to report and to identify risk factors for distal aortic failure following aortic arch replacement via the frozen elephant trunk (FET) procedure.
One hundred eighty-six consecutive patients underwent the FET procedure for acute and chronic aortic dissection. Our cohort was divided into patients with and without distal aortic failure. Distal aortic failure was defined as: (I) distal aortic reintervention, (II) aortic diameter dilatation to ≥ 6 cm or > 5 mm growth within 6 months, (III) development of a distal stent-graft-induced new entry (dSINE) and/or (IV) aortic-related death. Preoperative, intraoperative, postoperative and aortic morphological data were analyzed.
Distal aortic failure occurred in 88 (47.3%) patients. Forty-six (24.7%) required a distal reintervention, aortic diameter dilatation was observed in 9 (4.8%) patients, a dSINE occurred in 22 (11.8%) patients and 11 (6.4%) suffered an aortic-related death. We found no difference in the number of communications between true and false lumen ( = 0.25) but there were significantly more communications between Ishimaru zone 6-8 in the distal aortic failure group ( = 0.01). The volume of the thoracic descending aorta measured preoperatively and postoperatively within 36 months afterward was significantly larger in patients suffering distal aortic failure ( < 0.001; = 0.011). Acute aortic dissection (SHR 2.111; = 0.007), preoperative maximum descending aortic diameter (SHR 1.029; = 0.018) and preoperative maximum aortic diameter at the level of the diaphragm (SHR 1.041; = 0.012) were identified as risk factors for distal aortic failure.
The incidence and risk of distal aortic failure following the FET procedure is high. Especially those patients with more acute and more extensive aortic dissections or larger preoperative descending aortic diameters carry a substantially higher risk of developing distal aortic failure. The prospective of the FET technique as a single-step treatment for aortic dissection seems low and follow-up in dedicated aortic centers is therefore paramount.
本研究的目的是报告并确定经冷冻象鼻术（FET）行主动脉弓置换术后远端主动脉失败的危险因素。
186例连续性患者因急性和慢性主动脉夹层接受了FET手术。我们的队列分为有和没有远端主动脉失败的患者。远端主动脉失败定义为：（I）远端主动脉再次干预，（II）主动脉直径扩张至≥6 cm或在6个月内增长>5 mm，（III）出现远端支架移植物引起的新破口（dSINE）和/或（IV）与主动脉相关的死亡。分析术前、术中和术后以及主动脉形态学数据。
88例（47.3%）患者发生远端主动脉失败。46例（24.7%）需要进行远端再次干预，9例（4.8%）患者观察到主动脉直径扩张，22例（11.8%）患者出现dSINE，11例（6.4%）患者死于与主动脉相关的疾病。我们发现真腔和假腔之间的交通支数量没有差异（P = 0.25），但远端主动脉失败组在Ishimaru 6 - 8区之间的交通支明显更多（P = 0.01）。术后36个月内术前和术后测量的胸降主动脉体积在发生远端主动脉失败的患者中明显更大（P < 0.001；r = 0.011）。急性主动脉夹层（风险比2.111；P = 0.007）、术前最大降主动脉直径（风险比1.029；P = 0.018）和术前膈肌水平最大主动脉直径（风险比1.041；P = 0.012）被确定为远端主动脉失败的危险因素。
FET手术后远端主动脉失败的发生率和风险很高。特别是那些患有更急性、更广泛主动脉夹层或术前降主动脉直径更大的患者发生远端主动脉失败的风险要高得多。FET技术作为主动脉夹层单步治疗方法的前景似乎较低，因此在专门的主动脉中心进行随访至关重要。
