Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.

Wei Guo Ma; Wei Zhang; Long Fei Wang; Jun Zheng; Bulat A. Ziganshin; Paris Charilaou; Xu Dong Pan; Yong Min Liu; Jun Ming Zhu; Qian Chang; John A. Rizzo; John A. Elefteriades; Li Zhong Sun

doi:10.1016/j.jtcvs.2015.11.056

Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.

Wei Guo Ma
, Wei Zhang
, Long Fei Wang
, Jun Zheng
, Bulat A. Ziganshin
, Paris Charilaou
, Xu Dong Pan
, Yong Min Liu
, Jun Ming Zhu
, Qian Chang
, John A. Rizzo
, John A. Elefteriades
, Li Zhong Sun

Program in Public Health

Capital Medical University
Chinese Academy of Medical Sciences
Yale University

Research output: Contribution to journal › Article › peer-review

67 Scopus citations

Abstract

Objective To evaluate the efficacy of the frozen elephant trunk (FET) and total arch replacement (TAR) technique (FET + TAR) in the management of type A aortic dissection (TAAD) with arch entry tear. Methods Clinical outcomes were analyzed for 104 TAAD patients with arch entry tear undergoing FET + TAR at 4.7 ± 3.5 days from symptom onset and compared with 728 TAAD patients with entry tears in elsewhere. The mean patient age was 49.3 ± 9.3 years, compared with 45.6 ± 10.8 years in other TAAD patients (P <.001). There were 84 men (80.8%). Hypertension was seen in 84.6% (88/104). Results Operative mortality was 8.6% (9/104). Spinal cord injury occurred in 3 cases (2.9%), stroke in 2 (1.9%), renal failure in 4 (3.8%) and limb ischemia in 2 (1.9%). Follow-up was 100% (95/95) at mean 5.6 ± 2.6 years (range 1.3-11.6). Late death occurred in 2 cases (1.9%). Survival and freedom from late adverse events were 89.2% (95% confidence interval [CI], 81.3%-93.9%) and 85.0% (95% CI, 76.3%-90.8%) at 8 years, respectively. Both the stented and unstented distal aortic segments showed significant trends of false lumen shrinkage and true lumen expansion over time (P <.001). Of the 65 CT scans at mean 4.6 ± 2.9 years postoperatively, the false lumen was completely obliterated in 63. Risk factors for arch entry tear were hypertension (odds ratio [OR], 2.091; 95% CI, 1.186-3.687; P =.011) and age (OR, 1.025; 95% CI, 1.002-1.048; P =.032). Conclusions TAAD with arch entry tear was treated safely and durably by FET + TAR. Although patients with arch entry tear were somewhat older than other patients, operative mortality was not substantially higher despite their older age and arch location of entry tear. These results argue favorably for the use of the FET + TAR technique in the management of TAAD patients with arch entry tears.

Original language	English
Pages (from-to)	1581-1592
Number of pages	12
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	151
Issue number	6
DOIs	https://doi.org/10.1016/j.jtcvs.2015.11.056
State	Published - Jun 1 2016

Keywords

aorta
aortic dissection
blood vessel prosthesis
Kaplan-Meier estimate
mortality
thoracic/surgery
treatment outcome

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Ma, W. G., Zhang, W., Wang, L. F., Zheng, J., Ziganshin, B. A., Charilaou, P., Pan, X. D., Liu, Y. M., Zhu, J. M., Chang, Q., Rizzo, J. A., Elefteriades, J. A., & Sun, L. Z. (2016). Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015. Journal of Thoracic and Cardiovascular Surgery, 151(6), 1581-1592. https://doi.org/10.1016/j.jtcvs.2015.11.056

@article{d485d41498b14689a21cc72db604f670,

title = "Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.",

abstract = "Objective To evaluate the efficacy of the frozen elephant trunk (FET) and total arch replacement (TAR) technique (FET + TAR) in the management of type A aortic dissection (TAAD) with arch entry tear. Methods Clinical outcomes were analyzed for 104 TAAD patients with arch entry tear undergoing FET + TAR at 4.7 ± 3.5 days from symptom onset and compared with 728 TAAD patients with entry tears in elsewhere. The mean patient age was 49.3 ± 9.3 years, compared with 45.6 ± 10.8 years in other TAAD patients (P <.001). There were 84 men (80.8\%). Hypertension was seen in 84.6\% (88/104). Results Operative mortality was 8.6\% (9/104). Spinal cord injury occurred in 3 cases (2.9\%), stroke in 2 (1.9\%), renal failure in 4 (3.8\%) and limb ischemia in 2 (1.9\%). Follow-up was 100\% (95/95) at mean 5.6 ± 2.6 years (range 1.3-11.6). Late death occurred in 2 cases (1.9\%). Survival and freedom from late adverse events were 89.2\% (95\% confidence interval [CI], 81.3\%-93.9\%) and 85.0\% (95\% CI, 76.3\%-90.8\%) at 8 years, respectively. Both the stented and unstented distal aortic segments showed significant trends of false lumen shrinkage and true lumen expansion over time (P <.001). Of the 65 CT scans at mean 4.6 ± 2.9 years postoperatively, the false lumen was completely obliterated in 63. Risk factors for arch entry tear were hypertension (odds ratio [OR], 2.091; 95\% CI, 1.186-3.687; P =.011) and age (OR, 1.025; 95\% CI, 1.002-1.048; P =.032). Conclusions TAAD with arch entry tear was treated safely and durably by FET + TAR. Although patients with arch entry tear were somewhat older than other patients, operative mortality was not substantially higher despite their older age and arch location of entry tear. These results argue favorably for the use of the FET + TAR technique in the management of TAAD patients with arch entry tears.",

keywords = "aorta, aortic dissection, blood vessel prosthesis, Kaplan-Meier estimate, mortality, thoracic/surgery, treatment outcome",

author = "Ma, \{Wei Guo\} and Wei Zhang and Wang, \{Long Fei\} and Jun Zheng and Ziganshin, \{Bulat A.\} and Paris Charilaou and Pan, \{Xu Dong\} and Liu, \{Yong Min\} and Zhu, \{Jun Ming\} and Qian Chang and Rizzo, \{John A.\} and Elefteriades, \{John A.\} and Sun, \{Li Zhong\}",

note = "Publisher Copyright: Copyright {\textcopyright} 2016 by The American Association for Thoracic Surgery.",

year = "2016",

month = jun,

day = "1",

doi = "10.1016/j.jtcvs.2015.11.056",

language = "English",

volume = "151",

pages = "1581--1592",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

number = "6",

}

Ma, WG, Zhang, W, Wang, LF, Zheng, J, Ziganshin, BA, Charilaou, P, Pan, XD, Liu, YM, Zhu, JM, Chang, Q, Rizzo, JA, Elefteriades, JA & Sun, LZ 2016, 'Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.', Journal of Thoracic and Cardiovascular Surgery, vol. 151, no. 6, pp. 1581-1592. https://doi.org/10.1016/j.jtcvs.2015.11.056

Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015. / Ma, Wei Guo; Zhang, Wei; Wang, Long Fei et al.
In: Journal of Thoracic and Cardiovascular Surgery, Vol. 151, No. 6, 01.06.2016, p. 1581-1592.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Type A aortic dissection with arch entry tear

T2 - Surgical experience in 104 patients over a 12-year period Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.

AU - Ma, Wei Guo

AU - Zhang, Wei

AU - Wang, Long Fei

AU - Zheng, Jun

AU - Ziganshin, Bulat A.

AU - Charilaou, Paris

AU - Pan, Xu Dong

AU - Liu, Yong Min

AU - Zhu, Jun Ming

AU - Chang, Qian

AU - Rizzo, John A.

AU - Elefteriades, John A.

AU - Sun, Li Zhong

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Objective To evaluate the efficacy of the frozen elephant trunk (FET) and total arch replacement (TAR) technique (FET + TAR) in the management of type A aortic dissection (TAAD) with arch entry tear. Methods Clinical outcomes were analyzed for 104 TAAD patients with arch entry tear undergoing FET + TAR at 4.7 ± 3.5 days from symptom onset and compared with 728 TAAD patients with entry tears in elsewhere. The mean patient age was 49.3 ± 9.3 years, compared with 45.6 ± 10.8 years in other TAAD patients (P <.001). There were 84 men (80.8%). Hypertension was seen in 84.6% (88/104). Results Operative mortality was 8.6% (9/104). Spinal cord injury occurred in 3 cases (2.9%), stroke in 2 (1.9%), renal failure in 4 (3.8%) and limb ischemia in 2 (1.9%). Follow-up was 100% (95/95) at mean 5.6 ± 2.6 years (range 1.3-11.6). Late death occurred in 2 cases (1.9%). Survival and freedom from late adverse events were 89.2% (95% confidence interval [CI], 81.3%-93.9%) and 85.0% (95% CI, 76.3%-90.8%) at 8 years, respectively. Both the stented and unstented distal aortic segments showed significant trends of false lumen shrinkage and true lumen expansion over time (P <.001). Of the 65 CT scans at mean 4.6 ± 2.9 years postoperatively, the false lumen was completely obliterated in 63. Risk factors for arch entry tear were hypertension (odds ratio [OR], 2.091; 95% CI, 1.186-3.687; P =.011) and age (OR, 1.025; 95% CI, 1.002-1.048; P =.032). Conclusions TAAD with arch entry tear was treated safely and durably by FET + TAR. Although patients with arch entry tear were somewhat older than other patients, operative mortality was not substantially higher despite their older age and arch location of entry tear. These results argue favorably for the use of the FET + TAR technique in the management of TAAD patients with arch entry tears.

AB - Objective To evaluate the efficacy of the frozen elephant trunk (FET) and total arch replacement (TAR) technique (FET + TAR) in the management of type A aortic dissection (TAAD) with arch entry tear. Methods Clinical outcomes were analyzed for 104 TAAD patients with arch entry tear undergoing FET + TAR at 4.7 ± 3.5 days from symptom onset and compared with 728 TAAD patients with entry tears in elsewhere. The mean patient age was 49.3 ± 9.3 years, compared with 45.6 ± 10.8 years in other TAAD patients (P <.001). There were 84 men (80.8%). Hypertension was seen in 84.6% (88/104). Results Operative mortality was 8.6% (9/104). Spinal cord injury occurred in 3 cases (2.9%), stroke in 2 (1.9%), renal failure in 4 (3.8%) and limb ischemia in 2 (1.9%). Follow-up was 100% (95/95) at mean 5.6 ± 2.6 years (range 1.3-11.6). Late death occurred in 2 cases (1.9%). Survival and freedom from late adverse events were 89.2% (95% confidence interval [CI], 81.3%-93.9%) and 85.0% (95% CI, 76.3%-90.8%) at 8 years, respectively. Both the stented and unstented distal aortic segments showed significant trends of false lumen shrinkage and true lumen expansion over time (P <.001). Of the 65 CT scans at mean 4.6 ± 2.9 years postoperatively, the false lumen was completely obliterated in 63. Risk factors for arch entry tear were hypertension (odds ratio [OR], 2.091; 95% CI, 1.186-3.687; P =.011) and age (OR, 1.025; 95% CI, 1.002-1.048; P =.032). Conclusions TAAD with arch entry tear was treated safely and durably by FET + TAR. Although patients with arch entry tear were somewhat older than other patients, operative mortality was not substantially higher despite their older age and arch location of entry tear. These results argue favorably for the use of the FET + TAR technique in the management of TAAD patients with arch entry tears.

KW - aorta

KW - aortic dissection

KW - blood vessel prosthesis

KW - Kaplan-Meier estimate

KW - mortality

KW - thoracic/surgery

KW - treatment outcome

UR - https://www.scopus.com/pages/publications/84968754820

U2 - 10.1016/j.jtcvs.2015.11.056

DO - 10.1016/j.jtcvs.2015.11.056

M3 - Article

C2 - 26856470

AN - SCOPUS:84968754820

SN - 0022-5223

VL - 151

SP - 1581

EP - 1592

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 6

ER -

Ma WG, Zhang W, Wang LF, Zheng J, Ziganshin BA, Charilaou P et al. Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015. Journal of Thoracic and Cardiovascular Surgery. 2016 Jun 1;151(6):1581-1592. doi: 10.1016/j.jtcvs.2015.11.056

Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.

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Keywords

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