P357. Treatment of acute aortic dissection with primary entries in the arch and extension to descending aorta
SHANGHAI
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From Sep,2009 to Jun,2012, Dr Zhang Jing was training as PhD at department of vascular surgery, Fudan University affiliated Zhongshan Hospital, and involved in clinical management of a large number of complicated aortic diseases, standard training of open and endovascular surgery and series of clinical and basic research for aortic diseases.
Since Aug,2013, Dr Zhang Jing have worked at department of cardiovascular surgery of Shanghai Chest Hospital and focused on aortic and heart valve surgery, including aortic root surgery, mitral valve and aortic valve repair, open and endovascular procedure of aortic aneurysm and dissection.
In addition, Dr Zhang Jing actively participated, as PI or co-investigator, in several basic and clinical researches, including risks and mechanisms of aortic disease, CTA image reconstruction and analysis of aortic valve and root, MR 4D flow analysis of aortic root, computational finite-element analysis and 3D bioprinting.
Description
Methods: From 2001 to 2022, patients admitted emergently with a primary diagnosis of acute aortic dissection were screened, and a total of 57 candidates with Arch B aortic dissection were enrolled. The locations of the entries were determined by intraoperative inspection or angiography. Among these patients, 15 underwent total arch replacement (TAR) plus frozen elephant trunk, 14 underwent supra-arch debranching and retrograde stenting, and 28 underwent isolated endovascular intervention with fenestration or chimney technique. Baseline demographics, clinical outcomes including mortality and aortic reinterventions, and the computed tomography angiography-derived parameters of arch dimensions and remodeling, were compared across groups of different treatments. The median follow-up time was 55.5 months (interquartile range, 35-88 months).
Results: Overall mean age was 49.6 years (range, 26-80 years) with a male predominance (52/57, 91.2%). The in-hospital survival was comparable across 3 groups (14/15, 93.3% vs 13/14, 92.9% vs 28/28, 100%; log-rank P = 0.499), while there was a trend towards lower 5-year freedom from aortic reintervention in the TAR group (TAR vs non-TAR:100% vs 83.6% ± 6.8%, P = 0.057). At 5 years, the regressions of the arch and descending aorta were better in the TAR group than in non-TAR groups (aortic diameter at Zones 1-4: -1.2mm vs +0.01mm, P<0.001; -1.2mm vs +0.2mm, P<0.001; -1.6mm vs +0.14mm, P=0.001; and -0.6mm vs -0.10mm, P=0.121, respectively). The rate of complete descending aortic remodeling was also higher in the TAR group (66.7% vs 48.6%, P = 0.045).
Conclusions: In patients with acute Arch B aortic dissection, resection of the dissected arch may be beneficial with acceptable survival and superior freedom from aortic reintervention compared with non-resection treatments.
Authors
Jing Zhang (1), Wen-rui Ma (2), Xiaobin Zhang (1), Ye Kong (1), Jianfeng Zhang (1), dan zhu (3)
Institutions
(1) Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, (2) Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China, SHANGHAI, NA, (3) Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, NA