Distal Aortic Failure Following the Frozen Elephant Trunk Procedure for Aortic Dissection
BackgroundAim of this study was to report and to identify risk factors for distal aortic failure following aortic arch replacement via the frozen elephant trunk (FET) procedure.MethodsOne hundred eighty-six consecutive patients underwent the FET procedure for acute and chronic aortic dissection. Our...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.911548/full |
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| author | Tim Berger Miriam Graap Bartosz Rylski Albi Fagu Roman Gottardi Tim Walter Philipp Discher Muhammad Taha Hagar Stoyan Kondov Martin Czerny Maximilian Kreibich |
| author_facet | Tim Berger Miriam Graap Bartosz Rylski Albi Fagu Roman Gottardi Tim Walter Philipp Discher Muhammad Taha Hagar Stoyan Kondov Martin Czerny Maximilian Kreibich |
| author_sort | Tim Berger |
| collection | DOAJ |
| description | BackgroundAim of this study was to report and to identify risk factors for distal aortic failure following aortic arch replacement via the frozen elephant trunk (FET) procedure.MethodsOne hundred eighty-six consecutive patients underwent the FET procedure for acute and chronic aortic dissection. Our cohort was divided into patients with and without distal aortic failure. Distal aortic failure was defined as: (I) distal aortic reintervention, (II) aortic diameter dilatation to ≥ 6 cm or > 5 mm growth within 6 months, (III) development of a distal stent-graft-induced new entry (dSINE) and/or (IV) aortic-related death. Preoperative, intraoperative, postoperative and aortic morphological data were analyzed.ResultsDistal aortic failure occurred in 88 (47.3%) patients. Forty-six (24.7%) required a distal reintervention, aortic diameter dilatation was observed in 9 (4.8%) patients, a dSINE occurred in 22 (11.8%) patients and 11 (6.4%) suffered an aortic-related death. We found no difference in the number of communications between true and false lumen (p = 0.25) but there were significantly more communications between Ishimaru zone 6–8 in the distal aortic failure group (p = 0.01). The volume of the thoracic descending aorta measured preoperatively and postoperatively within 36 months afterward was significantly larger in patients suffering distal aortic failure (p < 0.001; p = 0.011). Acute aortic dissection (SHR 2.111; p = 0.007), preoperative maximum descending aortic diameter (SHR 1.029; p = 0.018) and preoperative maximum aortic diameter at the level of the diaphragm (SHR 1.041; p = 0.012) were identified as risk factors for distal aortic failure.ConclusionThe incidence and risk of distal aortic failure following the FET procedure is high. Especially those patients with more acute and more extensive aortic dissections or larger preoperative descending aortic diameters carry a substantially higher risk of developing distal aortic failure. The prospective of the FET technique as a single-step treatment for aortic dissection seems low and follow-up in dedicated aortic centers is therefore paramount. |
| first_indexed | 2024-04-12T14:25:22Z |
| format | Article |
| id | doaj.art-7ffcdf0fe7ce4cdf990390faad0d97e1 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T14:25:22Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-7ffcdf0fe7ce4cdf990390faad0d97e12022-12-22T03:29:27ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-06-01910.3389/fcvm.2022.911548911548Distal Aortic Failure Following the Frozen Elephant Trunk Procedure for Aortic DissectionTim Berger0Miriam Graap1Bartosz Rylski2Albi Fagu3Roman Gottardi4Tim Walter5Philipp Discher6Muhammad Taha Hagar7Stoyan Kondov8Martin Czerny9Maximilian Kreibich10Department of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyDepartment of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyDepartment of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyDepartment of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyDepartment of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyDepartment of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyDepartment of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyDepartment for Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Centre-University of Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyDepartment of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyDepartment of Cardiovascular Surgery, Faculty of Medicine, University Hospital Freiburg Heart Centre, University of Freiburg, Freiburg, GermanyBackgroundAim of this study was to report and to identify risk factors for distal aortic failure following aortic arch replacement via the frozen elephant trunk (FET) procedure.MethodsOne hundred eighty-six consecutive patients underwent the FET procedure for acute and chronic aortic dissection. Our cohort was divided into patients with and without distal aortic failure. Distal aortic failure was defined as: (I) distal aortic reintervention, (II) aortic diameter dilatation to ≥ 6 cm or > 5 mm growth within 6 months, (III) development of a distal stent-graft-induced new entry (dSINE) and/or (IV) aortic-related death. Preoperative, intraoperative, postoperative and aortic morphological data were analyzed.ResultsDistal aortic failure occurred in 88 (47.3%) patients. Forty-six (24.7%) required a distal reintervention, aortic diameter dilatation was observed in 9 (4.8%) patients, a dSINE occurred in 22 (11.8%) patients and 11 (6.4%) suffered an aortic-related death. We found no difference in the number of communications between true and false lumen (p = 0.25) but there were significantly more communications between Ishimaru zone 6–8 in the distal aortic failure group (p = 0.01). The volume of the thoracic descending aorta measured preoperatively and postoperatively within 36 months afterward was significantly larger in patients suffering distal aortic failure (p < 0.001; p = 0.011). Acute aortic dissection (SHR 2.111; p = 0.007), preoperative maximum descending aortic diameter (SHR 1.029; p = 0.018) and preoperative maximum aortic diameter at the level of the diaphragm (SHR 1.041; p = 0.012) were identified as risk factors for distal aortic failure.ConclusionThe incidence and risk of distal aortic failure following the FET procedure is high. Especially those patients with more acute and more extensive aortic dissections or larger preoperative descending aortic diameters carry a substantially higher risk of developing distal aortic failure. The prospective of the FET technique as a single-step treatment for aortic dissection seems low and follow-up in dedicated aortic centers is therefore paramount.https://www.frontiersin.org/articles/10.3389/fcvm.2022.911548/fullaortic dissectionfrozen elephant trunk (FET)distal aortic failureaortic reinterventiondSINE |
| spellingShingle | Tim Berger Miriam Graap Bartosz Rylski Albi Fagu Roman Gottardi Tim Walter Philipp Discher Muhammad Taha Hagar Stoyan Kondov Martin Czerny Maximilian Kreibich Distal Aortic Failure Following the Frozen Elephant Trunk Procedure for Aortic Dissection Frontiers in Cardiovascular Medicine aortic dissection frozen elephant trunk (FET) distal aortic failure aortic reintervention dSINE |
| title | Distal Aortic Failure Following the Frozen Elephant Trunk Procedure for Aortic Dissection |
| title_full | Distal Aortic Failure Following the Frozen Elephant Trunk Procedure for Aortic Dissection |
| title_fullStr | Distal Aortic Failure Following the Frozen Elephant Trunk Procedure for Aortic Dissection |
| title_full_unstemmed | Distal Aortic Failure Following the Frozen Elephant Trunk Procedure for Aortic Dissection |
| title_short | Distal Aortic Failure Following the Frozen Elephant Trunk Procedure for Aortic Dissection |
| title_sort | distal aortic failure following the frozen elephant trunk procedure for aortic dissection |
| topic | aortic dissection frozen elephant trunk (FET) distal aortic failure aortic reintervention dSINE |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.911548/full |
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