Chiu Pin-Han, Cheng Yu-Ting, Chang Feng-Cheng, Chen Chun-Yu, Chan Yi-Hsin, Chien-Chia Wu Victor, Chu Pao-Hsien, Chen Shao-Wei
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
Eur J Vasc Endovasc Surg. 2025 Jul 7. doi: 10.1016/j.ejvs.2025.07.003.
Type A acute aortic dissection (TAAAD) is associated with a high risk of surgical mortality despite early diagnosis and treatment. The optimal extent of aortic arch repair for primary TAAAD remains unclear. This study aimed to investigate the outcomes of the frozen elephant trunk (FET) procedure compared with non-FET procedures in patients with primary TAAAD.
This retrospective cohort study included patients who had undergone open TAAAD repair in Taiwan at any time between 1 January 2011 and 31 December 2020. Relevant data were collected from Taiwan's National Health Insurance Research Database. TAAAD was diagnosed in accordance with the International Classification of Diseases criteria. The type of aortic dissection (type A or B) and the use of FET were determined from insurance reimbursement codes. The in hospital outcome of primary interest was mortality. Late surgical outcomes included overall survival and re-operation. Late outcomes were evaluated for the interval between the date of hospital discharge after the index surgery and that of outcome occurrence, death, or database conclusion (31 December 2020).
This study included 5 769 patients, who were divided into FET and non-FET groups. Subsequently, these groups were subjected to 1:1 (n = 1 225) propensity score matching. In hospital mortality rate was statistically significantly higher in the FET group than in the non-FET group (22.4 vs. 18.0%, respectively; odds ratio [OR] 1.31; 95% confidence interval [CI] 1.07 - 1.60). The FET group exhibited a statistically significantly elevated rate of post-discharge all cause mortality (hazard ratio [HR] 1.20; 95% CI 1.03 - 1.39). The rate of re-operation after open aortic repair was statistically significantly lower in the FET group than in the non-FET group (0.7 vs. 3.0%, respectively; subdistribution HR 0.24; 95% CI 0.11 - 0.55). However, no statistically significant between group difference was observed in the rate of re-operation after any other aortic surgery. Surgical volume for TAAAD was correlated with in hospital mortality; this correlation was stronger in the non-FET group than in the FET group.
Patients who underwent FET for TAAAD had higher risks for in hospital mortality and post-operative complications compared with those that received non-FET procedures.
尽管进行了早期诊断和治疗，但A型急性主动脉夹层（TAAAD）的手术死亡率仍然很高。原发性TAAAD主动脉弓修复的最佳范围尚不清楚。本研究旨在调查原发性TAAAD患者中，与非冷冻象鼻术（FET）相比，冷冻象鼻术（FET）的手术效果。
这项回顾性队列研究纳入了2011年1月1日至2020年12月31日期间在台湾接受开放性TAAAD修复手术的患者。相关数据从台湾国民健康保险研究数据库中收集。TAAAD根据国际疾病分类标准进行诊断。主动脉夹层的类型（A型或B型）和FET的使用情况通过保险报销代码确定。主要关注的院内结局是死亡率。晚期手术结局包括总生存率和再次手术。晚期结局评估的时间间隔为首次手术出院日期至结局发生、死亡或数据库截止日期（2020年12月31日）。
本研究纳入了5769例患者，分为FET组和非FET组。随后，对这些组进行1:1（n = 1225）倾向评分匹配。FET组的院内死亡率在统计学上显著高于非FET组（分别为22.4%和18.0%；比值比[OR] 1.31；95%置信区间[CI] 1.07 - 1.60）。FET组出院后全因死亡率显著升高（风险比[HR] 1.20；95% CI 1.03 - 1.39）。FET组开放性主动脉修复术后再次手术率在统计学上显著低于非FET组（分别为0.7%和3.0%；亚分布HR 0.24；95% CI 0.11 - 0.55）。然而，在任何其他主动脉手术后的再次手术率方面，两组之间未观察到统计学上的显著差异。TAAAD的手术量与院内死亡率相关；这种相关性在非FET组中比在FET组中更强。
与接受非FET手术的患者相比，接受FET治疗TAAAD的患者院内死亡风险和术后并发症风险更高。
