Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients
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 progno...
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Frontiers Media S.A.
2021-07-01
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Series: | Frontiers in Cardiovascular Medicine |
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Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.689507/full |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jinzhang Li Jinzhang Li Jinzhang Li Lei Li Lei Li Maozhou Wang Maozhou Wang Haiyang Li Haiyang Li Lizhong Sun Yongmin Liu Ruixin Fan Zonggang Zhang Chengwei Zou Hongjia Zhang Hongjia Zhang Hongjia Zhang Ming Gong Ming Gong |
spellingShingle |
Jinzhang Li Jinzhang Li Jinzhang Li Lei Li Lei Li Maozhou Wang Maozhou Wang Haiyang Li Haiyang Li Lizhong Sun Yongmin Liu Ruixin Fan Zonggang Zhang Chengwei Zou Hongjia Zhang Hongjia Zhang Hongjia Zhang Ming Gong Ming Gong 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 acute aortic syndrome frozen elephant trunk hybrid aortic arch repair debranching prognosis |
author_facet |
Jinzhang Li Jinzhang Li Jinzhang Li Lei Li Lei Li Maozhou Wang Maozhou Wang Haiyang Li Haiyang Li Lizhong Sun Yongmin Liu Ruixin Fan Zonggang Zhang Chengwei Zou Hongjia Zhang Hongjia Zhang Hongjia Zhang Ming Gong Ming Gong |
author_sort |
Jinzhang Li |
title |
Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients |
title_short |
Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients |
title_full |
Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients |
title_fullStr |
Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients |
title_full_unstemmed |
Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients |
title_sort |
comparison of prognosis between hybrid debranching surgery and total open arch replacement with frozen elephant trunk for type a acute aortic syndrome patients |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Cardiovascular Medicine |
issn |
2297-055X |
publishDate |
2021-07-01 |
description |
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. |
topic |
acute aortic syndrome frozen elephant trunk hybrid aortic arch repair debranching prognosis |
url |
https://www.frontiersin.org/articles/10.3389/fcvm.2021.689507/full |
work_keys_str_mv |
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doaj-cb7f13a29c394618b63c4c1743553d282021-07-27T05:17:05ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-07-01810.3389/fcvm.2021.689507689507Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome PatientsJinzhang Li0Jinzhang Li1Jinzhang Li2Lei Li3Lei Li4Maozhou Wang5Maozhou Wang6Haiyang Li7Haiyang Li8Lizhong Sun9Yongmin Liu10Ruixin Fan11Zonggang Zhang12Chengwei Zou13Hongjia Zhang14Hongjia Zhang15Hongjia Zhang16Ming Gong17Ming Gong18Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaDepartment of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, ChinaBeijing Lab for Cardiovascular Precision Medicine, Beijing, ChinaDepartment of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaBeijing Lab for Cardiovascular Precision Medicine, Beijing, ChinaDepartment of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaBeijing Lab for Cardiovascular Precision Medicine, Beijing, ChinaDepartment of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaBeijing Lab for Cardiovascular Precision Medicine, Beijing, ChinaDepartment of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangzhou, ChinaDepartment of Cardiac Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, ChinaDepartment of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, ChinaDepartment of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaDepartment of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, ChinaBeijing Lab for Cardiovascular Precision Medicine, Beijing, ChinaDepartment of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaBeijing Lab for Cardiovascular Precision Medicine, Beijing, ChinaBackground: 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.https://www.frontiersin.org/articles/10.3389/fcvm.2021.689507/fullacute aortic syndromefrozen elephant trunkhybrid aortic arch repairdebranchingprognosis |