Mid-term results of hybrid arch repair for DeBakey type I aortic dissection.
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ABSTRACT:
SUBMITTER: Zhang L
PROVIDER: S-EPMC8869625 | biostudies-literature | 2021 May
REPOSITORIES: biostudies-literature
Publications
Mid-term results of hybrid arch repair for DeBakey type I aortic dissection.
Zhang Liang L Peng Zhan Z Yu Cuntao C Yang Xiubin X Qiu Juntao J Wang De
Chinese medical journal 20210519 4
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Project description:Background: This study employed three surgical techniques: total arch replacement (TAR) with frozen elephant trunk (FET), aortic balloon occlusion technique (ABO) and hybrid aortic arch repair (HAR) on patients with type I aortic dissection in Fuwai Hospital, aiming to compare the early outcomes of these surgical armamentariums. Methods: From January 2016 to December 2018, an overall 633 patients (431 of TAR+FET, 122 of HAR, and 80 of ABO) with type I aortic dissection were included in the study. Thirty-day mortality, stroke, paraplegia, re-exploration for bleeding, and renal replacement therapy were compared using the matching weight method (MWM). Results: After MWM process, the baseline characteristics were comparable among three TAR groups. It showed that ABO group had the longest cardiopulmonary bypass (p < 0.001) and aortic cross-clamp time (p < 0.001), while the operation time was longest in the HAR group (p = 0.039). There was no significant difference in 30-day mortality among groups (p = 0.783). Furthermore, the incidence of stroke (p = 0.679), paraplegia (p = 0.104), re-exploration for bleeding (p = 0.313), and CRRT (p = 0.834) demonstrated no significant difference. Of note, no significant differences were found regarding these outcomes even before using MWM. Conclusions: Based on the early outcomes, the three TAR approaches were equally applicable to type I aortic dissection. We may choose the specific procedure relatively flexibly according to patient status and surgeon's expertise. Importantly, long-term investigations are warranted to determine whether above approaches remain to be of equivalent efficacy and safety.
| S-EPMC8081908 | biostudies-literature
Project description: Not available
| S-EPMC11329172 | biostudies-literature
Project description:BackgroundIt is controversial if the type or the size of aortic dissection is associated with the mortality in patients with acute aortic dissection (AAD) type I or type II according to DeBakey. Due to the pronounced aortic pathology in DeBakey type I compared to DeBakey type II, it is to be expected, that the DeBakey type I is associated with a significant higher morbidity and mortality. But we hypothesize that the current advances in surgical techniques, circulatory management, and postoperative care improve the clinical outcome of patients with DeBakey type I and II. The purpose of this study was to evaluate retrospectively the effect of these parameters on surgical outcome in patients with DeBakey type I and type II in a large cohort study.MethodsFrom 2001 to 2019, 395 consecutive patients (34.2% female) underwent surgical aortic repair at our institution. Patients were retrospectively classified into 2 groups: patients with type 1 dissection (group 1: n=309, median age of 62.0 years) and patients with type 2 dissection (group 2: n=86, 67.5 years). Survival was estimated by Kaplan-Meier estimator. Risk factors were analyzed by logistic regression analysis.ResultsThe patients in group 1 suffered significantly more often from coronary heart disease [43 (13.9%) vs. 20 (23.3%), P=0.036]. Otherwise, there were no significant differences between both groups concerning preoperative risk factors. The median surgical duration (279 vs. 263 min, P=0.026) and the circulatory arrest time (35 vs. 27 min, P<0.001) in group 1 were significantly higher. In a significantly higher number of patients in group 1, the aortic arch was completely replaced (18.4% vs. 1.2%, P<0.001) and a simultaneous coronary artery bypass grafting [18 (5.8%) vs. 11 (12.8%), P=0.028] was performed. The rate of re-thoracotomy [62 (20.1%) vs. 9 (10.5%), P=0.040], of postoperative delirium [66 (21.4%) vs. 9 (10.6%), P=0.024], and of tracheotomy [85 (27.5%) vs. 14 (16.3%), P=0.034] were significantly higher in group 1. Thirty-day mortality was 15.7% and did not differ significantly between both groups (P=0.867), as well as the long-term survival rates (P=0.956).ConclusionsDue to the pronounced aortic pathology in type I compared to type II, it is to be expected, that the type I is associated with a significant higher morbidity and mortality. DeBakey type I was an independent predictor for 30-day mortality in our study, however, based on our 17-year single center experience there was no difference between the long-term survival in both groups.
| S-EPMC8743420 | biostudies-literature
Project description:ObjectivesTo investigate the midterm results after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection.MethodsBetween October 2014 and April 2021, 196 patients underwent zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. The true lumen area, aortic lumen area, and false lumen status were assessed at four aortic levels, the proximal and distal descending thoracic aorta (level A and level B, respectively), celiac artery branching (level C), and terminal aorta (level D). Aortic remodeling (postoperative area as a percentage of the preoperative area) was classified into 3 groups, positive (true lumen area ≥120% with aortic lumen <120% or true lumen area ≥80% with aortic lumen <80%), minimal (80% ≤ true lumen area and aortic lumen area <120%), and negative remodeling (all other changes).ResultsIn-hospital mortality was 13 (6.6%) patients. The overall survival rate was 85.1% at 5 years. The freedom from distal aortic reintervention was 89.9% at 5 years. The prevalence of completely thrombosed or obliterated false lumen at 2 years was 96.8% at level A, 88.4% at level B, 47.2% at level C, and 27.6% at level D. The prevalence of positive aortic remodeling at 2 years was 84.7% at level A, 75.0% at level B, 29.2% at level C, and 16.7% at level D.ConclusionsZone 0 arch repair with frozen elephant trunks for acute type A aortic dissection can avoid invasive aortic arch resection and facilitate aortic remodeling of the descending thoracic aorta. The FET effect on aortic remodeling is limited at the aortic level below the FET stent end.
| S-EPMC9366877 | biostudies-literature
Project description: Not available
| S-EPMC7817308 | biostudies-literature
Project description:Currently, there have been very few reports within the literature which specifically address using fenestrated and branched stent grafts to completely isolate and repair distal entry tears of chronic DeBakey IIIb aortic dissection. This study aimed to evaluate the clinical outcomes of a 3-dimensional (3D) printed aortic model-guided fenestrated stent in the treatment of distal tears of chronic DeBakey IIIb aortic dissection after thoracic endovascular aortic repair (TEVAR). The study was a one-center retrospective study comprising 36 patients who underwent TEVAR and fenestrated endovascular abdominal aortic repair (F-EVAR) between April 2014 and December 2022. Patient data was compiled and analysed for preoperative, intraoperative, and perioperative characteristics. In total, 36 patients (12 females and 24 males) were incorporated into this study. All of the patients included in this study had hypertension, and among them, the leading cause for undergoing II-stage F-EVAR was the progression of a false lumen, accounting for 24 cases (66.7% of the total). The technical success rate was 97.2% and there were no cases of 30-day mortality, myocardial infarction, permanent paraparesis, or organ failure. One year post-F-EVAR treatment, surviving patients showed significant false and true lumen remodelling with 100% complete false-lumen thrombosis. A total of five patients died during the follow-up, two patients died related to aorta complications and three patients died of heart failure, multiple organ failure, or septic shock. II-stage F-EVAR was safe and feasible operation to repair all distal tears of chronic DeBakey IIIb aortic dissection.
| S-EPMC10898741 | biostudies-literature
Project description:BackgroundThoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is greater than the risk of surgical complications. Depending on the cause, size and growth rate of the TAA, treatment may vary from close observation to emergency surgery. Aneurysms of the thoracic aorta can be managed by a number of surgical techniques. Open surgical repair (OSR) of aneurysms involves either partial or total replacement of the aorta, which is dependent on the extent of the diseased segment of the aorta. During OSR, the aneurysm is replaced with a synthetic graft. Hybrid repair (HR) involves a combination of open surgery with endovascular aortic stent graft placement. Hybrid repair requires varying degrees of invasiveness, depending on the number of supra-aortic branches that require debranching. The hybrid technique that combines supra-aortic vascular debranching with stent grafting of the aortic arch has been introduced as a therapeutic alternative. However, the short- and long-term outcomes of HR remain unclear, due to technical difficulties and complications as a result of the angulation of the aortic arch as well as handling of the arch during surgery.ObjectivesTo assess the effectiveness and safety of HR versus conventional OSR for the treatment of TAAs.Search methodsThe Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 22 March 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations.Selection criteriaWe considered for inclusion in the review all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing HR to OSR for TAAs.Data collection and analysisTwo review authors independently screened all titles and abstracts obtained from the literature search to identify those that met the inclusion criteria. We retrieved the full text of studies deemed as potentially relevant by at least one review author. The same review authors screened the full-text articles independently for inclusion or exclusion.Main resultsNo RCTs or CCTs met the inclusion criteria for this review.Authors' conclusionsDue to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of HR compared to OSR in people with TAAs, and we are unable to provide high-certainty evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs are necessary, addressing the objective of this review.
| S-EPMC8407084 | biostudies-literature
Project description:This report describes DeBakey Type I aortic dissection in a middle-aged hypertensive female who had undergone mitral tissue valve replacement a decade previously. The patient had severe abrupt onset tearing pain in her throat, back, and chest, for which she got admitted in a community hospital, where because of no changes in her ECG and biomarkers, the dissection of aorta was missed. She was subjected to coronary angiography more than 6 weeks later for pain in her left shoulder, which demonstrated normal vessels. She then underwent multi-detector computerised tomography aortogram (MD CTA) that revealed aortic dissection involving ascending, the arch, and descending thoracic and abdominal aorta. The patient declined surgical intervention and has been provided medical therapy in the form of high dose oral beta-blocker and losartan. The patient continues to be stable for the past 18 weeks since the index event. The report highlights the importance of detecting aortic dissection by keeping high index of clinical suspicion in a patient with abrupt onset tearing pain in the throat/back and employment of MD CTA.
| S-EPMC4699948 | biostudies-literature
Project description: Not available
| S-EPMC8311454 | biostudies-literature
Project description:The aortic arch repair is one of the most complex surgeries and carries a high risk of complications as well as mortality. Since 1975, when the arch repair was first done by Randall B. Griepp using hypothermic circulatory arrest, many new technologies were introduced. But even with the use of antegrade and retrograde perfusion techniques and improvement of surgical techniques and grafts, the rate of mortality, cerebral, spinal, and visceral damage was much higher as compared to any other cardiac surgeries. With further developments aimed at less invasive approaches, thoracic endovascular aortic repair (TEVAR) along with de-branching of supra-aortic vessels or the frozen elephant trunk was introduced. Here, in this article, we review the myriad of approaches to the aortic arch and have come to a conclusion that while traditional open surgery is considered as the gold standard for treatment of extensive aortic arch pathologies, one school of thought suggests hybrid techniques such as the frozen elephant trunk and aortic arch vessel de-branching as more appropriate procedures for high-risk patients, where co-morbidities may contraindicate cardiopulmonary bypass and longer operative times required for traditional repair. No randomized trials are present to compare between open and hybrid or endovascular procedure in normal or high-risk patients. The meta-analysis of most of the studies defines open surgery as the gold standard for arch pathology because the hybrid procedures did not provide any proven survival benefits or decrease in stroke rate and spinal ischemia when compared to open surgery in early, mid, or long-term results.
| S-EPMC7525865 | biostudies-literature