Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients

Frontiers in Cardiovascular Medicine

Jinzhang Li¹  Hongjia Zhang¹  Lei Li¹  Haiyang Li¹  Ming Gong¹  Maozhou Wang¹  Yongmin Liu²  Lizhong Sun²  Zonggang Zhang³  Ruixin Fan⁴  Chengwei Zou⁵ 

[1] Beijing Lab for Cardiovascular Precision Medicine, Beijing, China;Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China;Department of Cardiac Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China;Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangzhou, China;Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China;Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China;

关键词: acute aortic syndrome;    frozen elephant trunk;    hybrid aortic arch repair;    debranching;    prognosis;   

DOI  :  10.3389/fcvm.2021.689507

来源: DOAJ

【 摘 要 】

Background: It is unclear whether the total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and hybrid debranching surgery have a difference in the prognosis of patients with type A acute aortic syndrome (AAS). We attempted to compare the short-term and long-term prognosis of total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and hybrid debranching surgery in patients with type A acute aortic syndrome (AAS).Methods: From January 2014 to September 2020, a total of 518 patients who underwent TAR with FET surgery and 31 patients who underwent hybrid surgery were included. We analyzed the post-operative mortality and morbidity of complications of the two surgical methods, and we determined 67 patients for subgroup analysis through a 1:2 propensity score match (PSM). We identified risk factors for patient mortality and post-operative neurological complications through multivariate regression analysis.Results: Compared with the TAR with FET group, hybrid surgery could reduce aortic cross-clamp time, reduce intraoperative blood loss and prevent some patients from cardiopulmonary bypass. There was no significant difference in 30-day mortality between the TAR with FET group and the hybrid surgery group (10.6 vs. 9.7%). However, hybrid surgery had increased the incidence of permanent neurological complications in patients (95%CI: 4.7–35.7%, P = 0.001), especially post-operative cerebral infarction (P < 0.001). During the average follow-up period of 31.6 months, there was no significant difference in the 1-year survival rate and 3-year survival rate between the TAR with FET group and the hybrid surgery group (P = 0.811), but hybrid surgery increased the incidence of long-term neurological complications (P < 0.001). In multivariate regression analysis, surgical methods were not a risk factor for post-operative deaths, but hybrid surgery was a risk factor for post-operative neurological complications (P < 0.001).Conclusions: Hybrid surgery is an acceptable treatment for AAS, and its post-operative mortality is similar to FET. But hybrid surgery may increase the risk of permanent neurological complications after surgery, and this risk must be carefully considered when choosing hybrid surgery.

【 授权许可】

Unknown