Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm resultsCentral MessagePerspective
Objectives: To investigate the midterm results after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. Methods: Between October 2014 and April 2021, 196 patients underwent zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. The true lum...
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Elsevier
2022-08-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250722003431 |
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| author | Takuya Wada, MD Hiroshi Yamamoto, MD, PhD Daichi Takagi, MD, PhD Takayuki Kadohama, MD, PhD Gembu Yamaura, MD, PhD Kentaro Kiryu, MD, PhD Itaru Igarashi, MD |
| author_facet | Takuya Wada, MD Hiroshi Yamamoto, MD, PhD Daichi Takagi, MD, PhD Takayuki Kadohama, MD, PhD Gembu Yamaura, MD, PhD Kentaro Kiryu, MD, PhD Itaru Igarashi, MD |
| author_sort | Takuya Wada, MD |
| collection | DOAJ |
| description | Objectives: To investigate the midterm results after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. Methods: Between 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). Results: In-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. Conclusions: Zone 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. |
| format | Article |
| id | doaj-art-c3cc52c626104c9f90f52f6d991027b8 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2022-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-c3cc52c626104c9f90f52f6d991027b82025-08-20T04:01:57ZengElsevierJTCVS Techniques2666-25072022-08-0114293810.1016/j.xjtc.2022.05.013Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm resultsCentral MessagePerspectiveTakuya Wada, MD0Hiroshi Yamamoto, MD, PhD1Daichi Takagi, MD, PhD2Takayuki Kadohama, MD, PhD3Gembu Yamaura, MD, PhD4Kentaro Kiryu, MD, PhD5Itaru Igarashi, MD6Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, JapanAddress for reprints: Hiroshi Yamamoto, MD, PhD, Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, Akita 010-8543, Japan.; Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, JapanDepartment of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, JapanDepartment of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, JapanDepartment of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, JapanDepartment of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, JapanDepartment of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, JapanObjectives: To investigate the midterm results after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. Methods: Between 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). Results: In-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. Conclusions: Zone 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.http://www.sciencedirect.com/science/article/pii/S2666250722003431acute type A aortic dissectionzone 0 arch repairfrozen elephant trunkaortic remodelingdistal stent-induced new entry |
| spellingShingle | Takuya Wada, MD Hiroshi Yamamoto, MD, PhD Daichi Takagi, MD, PhD Takayuki Kadohama, MD, PhD Gembu Yamaura, MD, PhD Kentaro Kiryu, MD, PhD Itaru Igarashi, MD Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm resultsCentral MessagePerspective JTCVS Techniques acute type A aortic dissection zone 0 arch repair frozen elephant trunk aortic remodeling distal stent-induced new entry |
| title | Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm resultsCentral MessagePerspective |
| title_full | Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm resultsCentral MessagePerspective |
| title_fullStr | Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm resultsCentral MessagePerspective |
| title_full_unstemmed | Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm resultsCentral MessagePerspective |
| title_short | Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm resultsCentral MessagePerspective |
| title_sort | aortic remodeling reintervention and survival after zone 0 arch repair with frozen elephant trunks for acute type a aortic dissection midterm resultscentral messageperspective |
| topic | acute type A aortic dissection zone 0 arch repair frozen elephant trunk aortic remodeling distal stent-induced new entry |
| url | http://www.sciencedirect.com/science/article/pii/S2666250722003431 |
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