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Impact of Modified Frozen Elephant Trunk Procedure on Downstream Aorta Remodeling in Acute Aortic Dissection: CT Scan Follow-Up

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Abstract

Objectives

The aim was to evaluate the impact of a modified frozen elephant trunk procedure (mFET) on remodeling of the downstream aorta following acute aortic dissections.

Methods

Over a period of 8 years, 205 patients (mean age 62.6 ± 12.6 years) underwent a mFET (n = 69, 33.7%) or isolated ascending aorta replacement (n = 136, 66.3%) (iAoA). Aortic diameter was assessed at the aortic arch (AoA), at the mid of the thoracic aorta (mThA), at the thoracoabdominal transition (ThAbd) and at the celiac trunk level (AbdA).

Results

Mean follow-up was 3.3 ± 2.6 years. In-hospital mortality was 14% (n = 28), 7% in mFET and 17% in the iAoA group (p = 0.08). At the end of the follow-up, overall survival was 84% (95% CI 70–92%) and 75% (65–82%) and freedom from aorta-related reoperation was 100% and 95% (88–98%) for mFET and iAoA, respectively. At iAoA, the average difference in diameter change per year between mFET and iAoA was for total lumen 0 mm (− 0.95 to 0.94 mm, p = 0.99), and for true lumen, it was 1.23 mm (− 0.09 to 2.55 mm) per year, p = 0.067. False lumen demonstrated a decrease in diameter in mFET as compared to iAoA by − 1.43 mm (− 2.75 to − 0.11 mm), p = 0.034. In mFET, at the aortic arch level the total lumen diameter decreased from 30.7 ± 4.8 mm to 30.1 ± 2.5 mm (Δr  + 2.90 ± 3.64 mm) and in iAoA it increased from 31.8 ± 4.9 to 34.6 ± 5.9 mm (Δr + 2.88 ± 4.18 mm).

Conclusion

The mFET procedure provides satisfactory clinical outcome at short term and mid-term and has a positive impact on aorta remodeling, especially at the level of the aortic arch.

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Author notes

  1. Luca Koechlin and Josefin Kaufmann contributed equivalently to the manuscript.

Authors and Affiliations

  1. Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Luca Koechlin, Josefin Kaufmann, Evelina Macius, Brigitta Gahl, Ulrich Schurr, Martin Grapow, Oliver Reuthebuch, Friedrich Eckstein & Denis A. Berdajs

  2. Department of Radiology, University Hospital Basel, Basel, Switzerland

    Jens Bremerich & Gregor Sommer

Authors
  1. Luca Koechlin
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  2. Josefin Kaufmann
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  3. Evelina Macius
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  4. Jens Bremerich
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  5. Gregor Sommer
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  6. Brigitta Gahl
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  7. Ulrich Schurr
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  9. Oliver Reuthebuch
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  11. Denis A. Berdajs
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Correspondence to Denis A. Berdajs.

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Koechlin, L., Kaufmann, J., Macius, E. et al. Impact of Modified Frozen Elephant Trunk Procedure on Downstream Aorta Remodeling in Acute Aortic Dissection: CT Scan Follow-Up. World J Surg 44, 1648–1657 (2020). https://doi.org/10.1007/s00268-020-05374-9

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  • DOI: https://doi.org/10.1007/s00268-020-05374-9

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