The modified frozen elephant trunk may outperform limited and extended-classic repair in acute type I dissection

Eric E Roselli; Benjamin Kramer; Emidio Germano; Andrew Toth; Patrick R Vargo; Faisal Bakaeen; Venu Menon; Eugene H Blackstone; Collaborators from Cleveland Clinic Aorta Center

doi:10.1093/ejcts/ezad122

The modified frozen elephant trunk may outperform limited and extended-classic repair in acute type I dissection

Eur J Cardiothorac Surg. 2023 Jun 1;63(6):ezad122. doi: 10.1093/ejcts/ezad122.

Authors

Eric E Roselli^{1

2}, Benjamin Kramer², Emidio Germano², Andrew Toth³, Patrick R Vargo^{1

2}, Faisal Bakaeen^{1

2}, Venu Menon^{1

4}, Eugene H Blackstone^{2

3}; Collaborators from Cleveland Clinic Aorta Center

Collaborators

Collaborators from Cleveland Clinic Aorta Center:
Marc Gillinov, Gosta Pettersson, Edward Soltesz, Lars G Svensson, Daniel Burns, Kevin Hodges, Marijan Koprivanac, Francis Caputo, Sean Lyden, Levester Kirksey, Jon Quatromoni, Ali Khalifeh, Milind Desai, Vidyasagar Kalahasti, Brian Griffin, Richard Grimm, Paul Cremer, Bo Xu, Donald Hammer, Jay Ramchand, Maran Thamilarasan, Neha Quatromoni, Penelope Rampersad, Christine Jellis, Paul Schoenhagen, Michael Bolen, Christina Rigelsky, John Apostalakis, Andrew Bauer

Affiliations

¹ Aorta Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
² Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
³ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
⁴ Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Objectives: A better surgical approach for acute DeBakey type I dissection has been sought for decades. We compare operative trends, complications, reinterventions and survival after limited versus extended-classic versus modified frozen elephant trunk (mFET) repair for this condition.

Methods: From 1 January 1978 to 1 January 2018, 879 patients underwent surgery for acute DeBakey type I dissection at Cleveland Clinic. Repairs were limited to the ascending aorta/hemiarch (701.79%) or extended through the arch [extended classic (88.10%) or mFET (90.10%)]. Weighted propensity score matched established comparable groups.

Results: Among weighted propensity-matched patients, mFET repair had similar circulatory arrest times and postoperative complications to limited repair, except for postoperative renal failure, which was twice as high in the limited group [25% (n = 19) vs 12% (n = 9), P = 0.006]. Lower in-hospital mortality was observed following limited compared to extended-classic repair [9.1% (n = 7) vs 19% (n = 16), P = 0.03], but not after mFET repair [12% (n = 9) vs 9.5% (n = 8), P = 0.6]. Extended-classic repair had higher risk of early death than limited repair (P = 0.0005) with no difference between limited and mFET repair groups (P = 0.9); 7-year survival following mFET repair was 89% compared to 65% after limited repair. Most reinterventions following limited or extended-classic repair underwent open reintervention. All reinterventions following mFET repair were completed endovascularly.

Conclusions: Without increasing in-hospital mortality or complications, less renal failure and a trend towards improved intermediate survival, mFET may be superior to limited or extended-classic repair for acute DeBakey type I dissections. mFET repair facilitates endovascular reintervention, potentially reducing future invasive reoperations and warranting continued study.

Keywords: Acute aortic dissection; DeBakey type I; Hybrid repair; Renal failure.

MeSH terms

Aorta / surgery
Aorta, Thoracic / surgery
Aortic Aneurysm, Thoracic* / surgery
Aortic Dissection* / surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Humans
Postoperative Complications
Reoperation
Retrospective Studies
Treatment Outcome

Abstract

MeSH terms

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