In:
European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP)
Abstract:
To investigate the early and long-term outcomes after total arch replacement and frozen elephant trunk implantation in adult patients ≤30 years with acute type A aortic dissection. METHODS All young adult patients (≤30 years) with acute type A aortic dissection who underwent total arch replacement and frozen elephant trunk between 2009 and 2017 were enrolled. The end-points were major organ morbidity and mortality, aortic-related events, and reoperation. RESULTS The mean age of all 83 patients was 25.9 (standard deviation, 3.3) years. The in-hospital mortality was 9.64% (8/83), and 9 (10.8%) patients required re-exploration for bleeding. The aortic-related events risk was 42.7% (32/75) and aortic reoperation risk was 17.3% (13/75). Overall survival was 85.5% (95% CI, 75.9%–91.5%) at 5 years and 75.9% (95% CI, 63.3%–84.7%) at 10 years. The cumulative incidence of aortic-related events was 35% (95% CI, 24%–47%) at 5 years and 58% (95% CI, 36%–75%) at 10 years; the cumulative reoperation rate was 15% (95% CI, 7.9%–24%) at 5 years and 17% (95% CI, 9.2%–27%) at 10 years. Marfan syndrome significantly increased the aortic-related events (P = 0.036) and reoperation (P = 0.041) risks. CONCLUSIONS Despite extensive repair in young acute type A aortic dissection patients, the late aortic dilatation and reoperation risk remain high. The total arch replacement and frozen elephant trunk procedure achieved satisfactory early outcomes and reduced late aortic dilatation and reoperation in young patients compared with other records. Close follow-up and aggressive early reintervention are essential for patients with aortic-related risk factors early in life.
Type of Medium:
Online Resource
ISSN:
1010-7940
,
1873-734X
DOI:
10.1093/ejcts/ezad330
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2023
detail.hit.zdb_id:
1500330-9
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