Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm results

Takuya Wada; Hiroshi Yamamoto; Daichi Takagi; Takayuki Kadohama; Gembu Yamaura; Kentaro Kiryu; Itaru Igarashi

doi:10.1016/j.xjtc.2022.05.013

Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm results

JTCVS Tech. 2022 May 31:14:29-38. doi: 10.1016/j.xjtc.2022.05.013. eCollection 2022 Aug.

Authors

Takuya Wada¹, Hiroshi Yamamoto¹, Daichi Takagi¹, Takayuki Kadohama¹, Gembu Yamaura¹, Kentaro Kiryu¹, Itaru Igarashi¹

Affiliation

¹ Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan.

Abstract

Objectives: To investigate the midterm results after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection.

Methods: Between October 2014 and April 2021, 196 patients underwent zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. The true lumen area, aortic lumen area, and false lumen status were assessed at four aortic levels, the proximal and distal descending thoracic aorta (level A and level B, respectively), celiac artery branching (level C), and terminal aorta (level D). Aortic remodeling (postoperative area as a percentage of the preoperative area) was classified into 3 groups, positive (true lumen area ≥120% with aortic lumen <120% or true lumen area ≥80% with aortic lumen <80%), minimal (80% ≤ true lumen area and aortic lumen area <120%), and negative remodeling (all other changes).

Results: In-hospital mortality was 13 (6.6%) patients. The overall survival rate was 85.1% at 5 years. The freedom from distal aortic reintervention was 89.9% at 5 years. The prevalence of completely thrombosed or obliterated false lumen at 2 years was 96.8% at level A, 88.4% at level B, 47.2% at level C, and 27.6% at level D. The prevalence of positive aortic remodeling at 2 years was 84.7% at level A, 75.0% at level B, 29.2% at level C, and 16.7% at level D.

Conclusions: Zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection can avoid invasive aortic arch resection and facilitate aortic remodeling of the descending thoracic aorta. The FET effect on aortic remodeling is limited at the aortic level below the FET stent end.

Keywords: AL, aortic lumen; ATAAD, acute type A aortic dissection; CPB, cardiopulmonary bypass; CT, computed tomography; FET, frozen elephant trunk; FL, false lumen; TAR, total arch replacement; TEVAR, thoracic endovascular aortic repair; TL, true lumen; Z-0-FET, zone 0 arch repair with frozen elephant trunk; acute type A aortic dissection; aortic remodeling; dSINE, distal stent graft-induced new entry; distal stent-induced new entry; frozen elephant trunk; zone 0 arch repair.