Akita Sho, Tokuda Yoshiyuki, Narita Yuji, Terazawa Sachie, Yoshizumi Tomo, Ito Hideki, Mutsuga Masato
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya, Aichi, 466-8560, Japan.
Gen Thorac Cardiovasc Surg. 2025 Feb 6. doi: 10.1007/s11748-025-02122-5.
The frozen elephant trunk (FET) procedure has emerged as an effective single-stage treatment for complex aortic pathologies. However, it carries a risk of distal stent graft-induced new entry (dSINE) in patients with chronic aortic dissection (CAD). This study investigated risk factors associated with dSINE development.
Between 2009 and 2021, 160 FET procedures were performed, including 48 cases of CAD (mean time from onset: 5.6 ± 3.8 years). After excluding five patients due to incomplete 6-month postoperative computed tomography (CT) data, 43 patients were included. A multivariable stepwise Cox proportional hazards regression analysis was conducted to identify predictors of dSINE.
During a mean follow-up period of 5.9 ± 3.9 years, dSINE occurred in 22 of 43 patients (51.1%). Univariate analysis identified three significant risk factors for dSINE: total aortic diameter (TAD) > 45 mm at the distal stent-graft level (HR 5.88, 95% CI 1.35-25.52, p = 0.018), True lumen (TL) perimeter-based diameter (HR 1.22, 95% CI 1.03-1.46; p = 0.021), and TL ovality (HR 1.31, 95% CI 1.04-1.65, p = 0.022). Multivariate analysis revealed TAD > 45 mm as an independent risk factor for dSINE (HR 4.60, 95% CI 1.01-20.85, p = 0.048). The 5-year freedom from dSINE was significantly higher in patients with TAD ≤ 45 mm compared to those with TAD > 45 mm (87.5% vs. 20.8%, p < 0.01).
Although FET remains an important therapeutic option for CAD, dSINE represents a significant postoperative complication. TAD > 45 mm was identified as an independent risk factor. These findings may guide surgical planning for FET procedures.
冷冻象鼻术（FET）已成为治疗复杂主动脉病变的一种有效的单阶段治疗方法。然而，对于慢性主动脉夹层（CAD）患者，它存在远端支架移植物导致新破口（dSINE）的风险。本研究调查了与dSINE发生相关的危险因素。
2009年至2021年间，共进行了160例FET手术，其中包括48例CAD患者（发病平均时间：5.6±3.8年）。在排除5例术后6个月计算机断层扫描（CT）数据不完整的患者后，纳入43例患者。进行多变量逐步Cox比例风险回归分析以确定dSINE的预测因素。
在平均5.9±3.9年的随访期内，43例患者中有22例（51.1%）发生了dSINE。单因素分析确定了dSINE的三个显著危险因素：远端支架移植物水平的主动脉总直径（TAD）>45mm（风险比[HR]5.88，95%置信区间[CI]1.35 - 25.52，p = 0.018）、基于真腔（TL）周长的直径（HR 1.22，95%CI 1.03 - 1.46；p = 0.021）和TL椭圆度（HR 1.31，95%CI 1.04 - 1.65，p = 0.022）。多因素分析显示TAD>45mm是dSINE的独立危险因素（HR 4.60，95%CI 1.01 - 20.85，p = 0.048）。与TAD>45mm的患者相比，TAD≤45mm的患者5年无dSINE发生率显著更高（87.5%对20.8%，p<0.01）。
尽管FET仍然是CAD的重要治疗选择，但dSINE是一种重要的术后并发症。TAD>45mm被确定为独立危险因素。这些发现可能指导FET手术的手术规划。
