Contemporary Surgical Outcomes of Acute Type A Aortic Dissection in a Single Center

P0094 

Abstract Submission 

Daisuke Takahashi (1), Norihiko Shiiya (1), Naoki Washiyama (1), Kazumasa Tsuda (1)

(1) Hamamatsu University Hospital, Hamamatsu, Japan

Daisuke Takahashi    -  Contact Me
Hamamatsu University Hospital

*Norihiko Shiiya    -  Contact Me
Hamamatsu University Hospital

Naoki Washiyama    -  Contact Me
Hamamatsu University Hospital

Kazumasa Tsuda    -  Contact Me
Hamamatsu University Hospital

Daisuke Takahashi    -  Contact Me
N/A

Objective: The use of a frozen elephant trunk has been reported to improve the long-term outcomes of acute type A aortic dissection. The fenestrated elephant trunk operation has recently been introduced to simplify arch vessel reconstruction. We employ the tear-oriented replacement strategy and use the frozen elephant trunk selectively. The aim of this study was to review the early and long-term outcomes of surgical treatment for acute type A aortic dissection in our hospital.
Methods: One hundred and forty-two patients who underwent emergent surgery for acute type A aortic dissection from January 2010 to November 2023 were included in this study. All the operations were performed using selective antegrade cerebral perfusion under moderate hypothermia. To prevent anastomotic leakage into the false lumen, we reinforced the aortic stump with a Dacron strip internally and a Teflon felt externally, and glued the false lumen using the Bioglue. Frozen elephant trunk was used for younger patients and those with dynamic malperfusion of the lower torso since November 2017. Patient characteristics and surgical outcomes were retrospectively evaluated. The median observation period was 77 months (0.2 - 170).
Results: Mean age was 68±13 (range 32-91) years. Seventy-three (51%) were male. Preoperative cardiopulmonary resuscitation (CPR) was required in 7 patients (5%). There were 128 classical dissection (90%). Thirty-two patients (23%) had cardiac tamponade and 44 (31%) had organ malperfusion (coronary 5; brain 16; mesenteric 3; renal 7; lower limb 20). Surgical procedures included 59 ascending or hemiarch replacement (5 with aortic root replacement), 40 partial arch replacement (1 or 2 separate tube grafts for arch vessel reconstruction; 1 with aortic root replacement), and 28 total arch replacement (7 with root replacement). Frozen elephant trunk was used in 28 (20%). Distal aortic anastomosis was created at zone-2 in 20 and zone-3 in 8. The trunk was fenestrated in 11. In-hospital mortality was 4.2% (6 of 142). Multivariable analysis revealed that preoperative CPR was an independent predictor of hospital death. The survival rate including in-hospital mortality was 91% at 1 year, 89% at 3 years, and 86% at 5 years. There were 13 late deaths including 4 aorta-related deaths (1 month, 2 months, 5 years, and 10 years). Freedom from reoperation rate was 98% at 1 year, 97% at 3 years, and 93% at 5 years. There were 7 reoperations. The causes of reoperations included 2 proximal pseudoaneurysms at 5 and 7 years, 1 distal pseudoaneurysm at 4 years, 1 distal aortic dilatation at 6 years, 1 SINE at 4 months, graft infection (Salmonella) at 2 years, and 1 endoleak of fenestrated frozen elephant trunk at 6 months. There was no mortality after reoperation.
Conclusions: Contemporary early and long-term surgical outcome of acute type A aortic dissection was excellent. Our tear-oriented strategy and selective use of the frozen elephant trunk seem justified.

Dissection