Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique.

Congcong Luo,Suwei Chen,Junming Zhu,Hao Liu,Ruidong Qi,Yipeng Ge,Yongliang Zhong,Lizhong Sun,Rutao Guo

doi:10.3389/fcvm.2021.714638

Congcong Luo, Suwei Chen + Show 7 more

Open Access

https://doi.org/10.3389/fcvm.2021.714638

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Abstract

Background: This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection.Methods: From February 2009 to December 2019, 79 patients diagnosed with chronic type B or non-A non-B aortic dissection who underwent the FET procedure were included in the present study. We analyzed operation mortality and early and long-term outcomes, including complications, survival and interventions.Results: The operation mortality rate was 5.1% (4/79). Spinal cord injury occurred in 3.8% (3/79), stroke in 2.5% (2/79), and acute renal failure in 5.1% (4/79). The median follow-up time was 53 months. The overall survival rates were 96.2, 92.3, 88.0, 79.8, and 76.2% at 1/2, 1, 3, 5 and 7 years, respectively. Moreover, 79.3% of patients did not require distal aortic reintervention at 7 years. The overall survival in the subacute group was superior to that in the chronic group (P = 0.047).Conclusion: The FET technique is a safe and feasible approach for treating chronic type B and non-A non-B aortic dissection in patients who have contraindications for primary endovascular aortic repair. The technique combines the advantages of both open surgical repair and endovascular intervention, providing comparable early and long-term follow-up outcomes and freedom from reintervention.

Highlights

According to current expert consensus, patients with uncomplicated type B aortic dissection (AD) are suggested for medical treatment and periodic clinical and imaging surveillance
The frozen elephant trunk (FET) procedure may be an alternative treatment for these kinds of patients, according to the recent recommendations published by the European Society for Vascular Surgery and the European Association for Cardio-Thoracic Surgery [5, 6]
The FET procedure combines the advantages of open surgery and endovascular treatment, by which total arch replacement (TAR) and descending aortic dissection repair [7, 8] can be performed simultaneously

Summary

Introduction

According to current expert consensus, patients with uncomplicated type B aortic dissection (AD) are suggested for medical treatment and periodic clinical and imaging surveillance. Thoracic endovascular aortic repair (TEVAR) has been recommended as the firstline treatment for complicated type B or non-A non-B AD because of its lower morbidity and mortality [4]. The frozen elephant trunk (FET) procedure may be an alternative treatment for these kinds of patients, according to the recent recommendations published by the European Society for Vascular Surgery and the European Association for Cardio-Thoracic Surgery [5, 6]. There have been few reports on the outcomes of chronic type B or non-A non-B AD using the FET procedure, and the long-term outcomes, in particular, have not been reported [10]. This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection

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