Fate of distal aorta after frozen elephant trunk and total arch replacement for type A aortic dissection in Marfan syndrome

The Journal of Thoracic and Cardiovascular Surgery

Ai-Hua Zhi¹  Yu Chen²  Lingeng Lu³  Wei-Guo Ma⁴ 

[1] Aortic Institute at Yale-New Haven, Yale School of Medicine, New Haven, Conn;Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China;Department of Chronic Disease Epidemiology, Yale School of Public Health and Center for Biomedical Data Science, Yale School of Medicine, New Haven, Conn;Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China

关键词: aortic dissection;    computed tomography;    frozen elephant trunk;    longitudinal analysis;    Marfan syndrome;    reoperation;    survival;   

DOI  :  10.1016/j.jtcvs.2018.07.096

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveThe use of the frozen elephant trunk technique for type A aortic dissection in Marfan syndrome is limited by the lack of imaging evidence for long-term aortic remodeling. We seek to evaluate the changes of the distal aorta and late outcomes after frozen elephant trunk and total arch replacement for type A aortic dissection in patients with Marfan syndrome.MethodsBetween 2003 and 2015, we performed frozen elephant trunk + total arch replacement for 172 patients with Marfan syndrome suffering from type A aortic dissection (94 acute; 78 chronic). Mean age was 34.6 ± 9.3 years, and 121 were male (70.3%). Early mortality was 8.1% (14/172), and follow-up was complete in 98.7% (156/158) at a mean of 6.2 ± 3.3 years. Aortic dilatation was defined as a maximal diameter of greater than 50 mm or an average growth rate of greater than 5 mm/year at any segment detected by computed tomographic angiography. Temporal changes in the false and true lumens and maximal aortic size were analyzed with linear mixed modeling.ResultsAfter surgery, false lumen obliteration occurred in 86%, 39%, 26%, and 21% at the frozen elephant trunk, unstented descending aorta, diaphragm, and renal artery, respectively. The true lumen expanded significantly over time at all segments (P P P > .05). Maximal aortic size was stable at the frozen elephant trunk and renal artery (P > .05), but grew at the descending aorta (P = .001) and diaphragm (P P P P P = .014), and late death (hazard ratio, 3.31; P = .045).ConclusionsThe frozen elephant trunk technique can expand the true lumen across the aorta, decrease or stabilize the false lumen, and stabilize the distal aorta in patients with Marfan syndrome with type A aortic dissection, thereby inducing favorable remodeling in the distal aorta. This study adds long-term clinical and radiologic evidence supporting the use of the frozen elephant trunk technique for type A dissection in Marfan syndrome.

【 授权许可】

Unknown