Shi Sum Poon1, David H Tian2, Tristan Yan3, Deborah Harrington1, Omar Nawaytou1, Manoj Kuduvalli1, Axel Haverich4, Marek Ehrlich5, Wei-Guo Ma6, Li-Zhong Sun6, Anthony L Estrera7, Mark Field8. 1. Liverpool Centre for Cardiovascular Science, Thoracic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. 2. The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia. 3. The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia. 4. Department of Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany. 5. Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria. 6. Beijing Aortic Disease Centre, Beijing Institute of Heart, Lung and Blood Vessel Diseases and Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 7. Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Centre at Houston (UTHealth), Houston, Tex. 8. Liverpool Centre for Cardiovascular Science, Thoracic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. Electronic address: mark.field@lhch.nhs.uk.
Abstract
OBJECTIVE: We seek to assess the safety of total arch replacement with frozen elephant trunk for acute type A aortic dissection in respect to the risks of operative mortality, stroke, and paraplegia using an international multicenter registry (ARCH). METHODS: The ARCH Registry database from 37 participating centers was analyzed between 2000 and 2015. Patients who underwent emergency surgery for acute type A aortic dissection treated by total arch replacement with or without frozen elephant trunk were included. Operative mortality, permanent neurologic deficits, and spinal cord injury were primary end points. These end points were analyzed using univariate and hierarchical multivariate regression analyses, as well as conditional logistic regression analysis and post hoc propensity-score stratification. RESULTS: A total of 11,928 patients were enrolled in the ARCH database, of which 6180 were managed with total arch replacement. A comprehensive analysis was performed for 978 patients who underwent total aortic arch replacement for acute type A aortic dissection with or without frozen elephant trunk placement. In propensity-score matching, there were no significant differences between total arch replacement and frozen elephant trunk in terms of permanent neurologic deficits (11.9% vs 10.1%, P = .59) and spinal cord injury (4.0% vs 6.3%, P = .52) For patients included in the post hoc propensity-score stratification, frozen elephant trunk was associated with a statistically significantly lower mortality risk (odds ratio, 0.47; P = .03). CONCLUSIONS: The use of frozen elephant trunk for acute type A aortic dissection does not appear to increase the risk of paraplegia in appropriately selected patients at experienced centers. The exact risk factors for paraplegia remain to be determined.
OBJECTIVE: We seek to assess the safety of total arch replacement with frozen elephant trunk for acute type A aortic dissection in respect to the risks of operative mortality, stroke, and paraplegia using an international multicenter registry (ARCH). METHODS: The ARCH Registry database from 37 participating centers was analyzed between 2000 and 2015. Patients who underwent emergency surgery for acute type A aortic dissection treated by total arch replacement with or without frozen elephant trunk were included. Operative mortality, permanent neurologic deficits, and spinal cord injury were primary end points. These end points were analyzed using univariate and hierarchical multivariate regression analyses, as well as conditional logistic regression analysis and post hoc propensity-score stratification. RESULTS: A total of 11,928 patients were enrolled in the ARCH database, of which 6180 were managed with total arch replacement. A comprehensive analysis was performed for 978 patients who underwent total aortic arch replacement for acute type A aortic dissection with or without frozen elephant trunk placement. In propensity-score matching, there were no significant differences between total arch replacement and frozen elephant trunk in terms of permanent neurologic deficits (11.9% vs 10.1%, P = .59) and spinal cord injury (4.0% vs 6.3%, P = .52) For patients included in the post hoc propensity-score stratification, frozen elephant trunk was associated with a statistically significantly lower mortality risk (odds ratio, 0.47; P = .03). CONCLUSIONS: The use of frozen elephant trunk for acute type A aortic dissection does not appear to increase the risk of paraplegia in appropriately selected patients at experienced centers. The exact risk factors for paraplegia remain to be determined.
Authors: Mohammed Idhrees; Mohammed Ibrahim; Murali Krishnaswami; Aju Jacob; Bashi Velayudhan Journal: Indian J Thorac Cardiovasc Surg Date: 2020-09-05
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Authors: Nicholas A Vernice; Matthew E Wingo; Paul B Walker; Michelle Demetres; Lily N Stalter; Qiuyu Yang; Andreas R de Biasi Journal: J Card Surg Date: 2022-05-08 Impact factor: 1.778