Wei-Guo Ma1, Jun Zheng2, Wei Zhang3, Kai Sun4, Bulat A Ziganshin5, Long-Fei Wang3, Rui-Dong Qi2, Yong-Min Liu2, Jun-Ming Zhu2, Qian Chang4, John A Elefteriades5, Li-Zhong Sun6. 1. Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China; Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn. 2. Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China. 3. Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China. 4. Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China. 5. Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn. 6. Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China. Electronic address: lizhongsun@outlook.com.
Abstract
OBJECTIVE: We seek to compare the early outcomes of frozen elephant trunk with total aortic arch replacement using a 4-branched graft (the Sun procedure) in patients with acute and chronic type A aortic dissection (TAAD), identify the risk factors for operative mortality, and determine whether the acuity of TAAD significantly affects operative mortality. METHODS: We performed univariate and multivariate analyses of the clinical data from 803 patients with TAAD who underwent the Sun procedure. RESULTS: The operative mortality was 6.5% (52 of 803). The overall incidence of stroke and spinal cord injury was 2.0% (16 of 803) and 2.4% (19 of 803), respectively. Patients with acute TAAD had a greater incidence of operative death (8.1% vs 4.3%; P = .031), stroke (2.2% vs 0.6%; P = .046), and respiratory morbidities (20.8% vs 8.6%; P < .001). However, acuity was not identified as a risk factor for operative mortality (odds ratio [OR], 1.67; P = .152). The risk factors were previous cerebrovascular disease (OR, 7.01; P = .001); malperfusion of the brain (OR, 7.10; P = .002), kidneys (OR, 12.67; P = .005), spinal cord (OR, 22.79; P = .008), and viscera (OR 22.98; P = .002); concomitant extra-anatomic bypass (OR, 9.50; P < .001); and cardiopulmonary bypass time >180 minutes (OR, 1.01; P < .001). CONCLUSIONS: In this group of patients with type A dissection, acuity was not a risk factor for operative mortality after the Sun procedure. Patients with previous cerebrovascular disease; malperfusion of the brain, kidneys, spinal cord, and/or viscera; concomitant extra-anatomic bypass; and a longer cardiopulmonary bypass time (>180 minutes) were at greater risk of operative mortality.
OBJECTIVE: We seek to compare the early outcomes of frozen elephant trunk with total aortic arch replacement using a 4-branched graft (the Sun procedure) in patients with acute and chronic type A aortic dissection (TAAD), identify the risk factors for operative mortality, and determine whether the acuity of TAAD significantly affects operative mortality. METHODS: We performed univariate and multivariate analyses of the clinical data from 803 patients with TAAD who underwent the Sun procedure. RESULTS: The operative mortality was 6.5% (52 of 803). The overall incidence of stroke and spinal cord injury was 2.0% (16 of 803) and 2.4% (19 of 803), respectively. Patients with acute TAAD had a greater incidence of operative death (8.1% vs 4.3%; P = .031), stroke (2.2% vs 0.6%; P = .046), and respiratory morbidities (20.8% vs 8.6%; P < .001). However, acuity was not identified as a risk factor for operative mortality (odds ratio [OR], 1.67; P = .152). The risk factors were previous cerebrovascular disease (OR, 7.01; P = .001); malperfusion of the brain (OR, 7.10; P = .002), kidneys (OR, 12.67; P = .005), spinal cord (OR, 22.79; P = .008), and viscera (OR 22.98; P = .002); concomitant extra-anatomic bypass (OR, 9.50; P < .001); and cardiopulmonary bypass time >180 minutes (OR, 1.01; P < .001). CONCLUSIONS: In this group of patients with type A dissection, acuity was not a risk factor for operative mortality after the Sun procedure. Patients with previous cerebrovascular disease; malperfusion of the brain, kidneys, spinal cord, and/or viscera; concomitant extra-anatomic bypass; and a longer cardiopulmonary bypass time (>180 minutes) were at greater risk of operative mortality.
Authors: Kai Zhang; Xu-Dong Pan; Song-Bo Dong; Jun Zheng; Shang-Dong Xu; Yong-Min Liu; Jun-Ming Zhu; Li-Zhong Sun Journal: J Int Med Res Date: 2020-11 Impact factor: 1.671