Details

Autor(en) / Beteiligte

• Ma, Wei-Guo, MD, PhD
• Zhang, Wei, MD
• Zhu, Jun-Ming, MD
• Ziganshin, Bulat A., MD
• Zhi, Ai-Hua, MD
• Zheng, Jun, MD, PhD
• Liu, Yong-Min, MD
• Elefteriades, John A., MD
• Sun, Li-Zhong, MD

Titel

Long-Term Outcomes of Frozen Elephant Trunk for Type A Aortic Dissection in Patients with Marfan Syndrome

Ist Teil von

• The Journal of thoracic and cardiovascular surgery, 2017-10, Vol.154 (4), p.1175-1189.e2

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Objective To evaluate the efficacy of frozen elephant trunk (FET) and total arch replacement (TAR) for type A aortic dissection (TAAD) in patients with Marfan syndrome (MFS). Methods The early and long-term outcomes were analyzed for 106 patients with MFS (age 34.5±9.7 years) undergoing FET+TAR for TAAD. Results Operative mortality was 6.6% (7/106). Spinal cord injury and stroke occurred in 1 case each (0.9%), and reexploration for bleeding in 6 (5.7%). Extra-anatomic bypass was a risk factor for operative mortality and morbidity (odds ratio [OR], 7.120; 95% confidence interval [CI], 1.018-49.790; P = .048). Follow-up was complete in 97.0% (96/99) averaging 6.3±2.8 years. Late death occurred in 17 patients. Patients with acute TAAD were less prone to late death than those with chronic TAAD (OR, 0.112; 95% CI, 0.021-0.587; P = .048). Late reoperations were needed in 12 patients, including thoracoabdominal aortic repair in 8, TEVAR for distal new entry in 3 and coronary anastomotic repair in 1. At 5 and 8 years, survival was 86.6% and 74.1% (95% CI, 77.9-92.0% and 61.9-83.0%), and freedom from reoperation was 88.8% and 84.2% (95% CI, 80.1-93.4% and 72.4-91.2%), respectively. Competing risks analyses showed that at 5, 8 and 10 years, the rate was 4%, 18% and 25% for death, 10%, 15% and 15% for reoperation, and 86%, 67%, and 60% for survival without reoperation, respectively. Survival was significantly higher in patients with root procedures during FET+TAR ( P = .047). Risk factors for reoperation were days from diagnosis to surgery (OR, 1.160; 95% CI, 1.043-1.289; P = .006) and Bentall procedure (OR, 12.012; 95% CI, 1.041-138.606; P = .046). Conclusions FET+TAR can be safely performed for TAAD in MFS with low operative mortality, favorable long-term survival and freedom from reoperation. A concomitant Bentall procedure was predictive of better long-term survival and increased risk for late reoperation. These results argue favorably for the use of FET+TAR in management of TAAD in MFS.