TY - JOUR
T1 - Frozen Elephant Trunk for Aortic Arch Reconstruction is Associated with Reduced Mortality as Compared to Conventional Techniques
AU - Canadian Thoracic Aortic Collaborative
AU - Hage, Ali
AU - Hage, Fadi
AU - Dagenais, Francois
AU - Ouzounian, Maral
AU - Chung, Jennifer
AU - El-Hamamsy, Ismail
AU - Peterson, Mark D.
AU - Boodhwani, Munir
AU - Bozinovski, John
AU - Moon, Michael C.
AU - Yamashita, Michael
AU - Chu, Michael W.A.
AU - Cartier, Andreanne
AU - Chauvette, Vincent
AU - Guo, Ming
AU - White, Abigail
AU - Lodewyks, Carly
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - To examine the perioperative outcomes following aortic arch repair using frozen elephant trunk (FET) vs conventional elephant trunk (ET) techniques. Between 2002 and 2018, 390 patients underwent aortic repair with elephant trunk reconstruction at 9 centers: 172 patients received a FET (mean age: 65+/-13 years, 30% female, 37% aortic dissection) and 218 patients received an ET (mean age: 63+/-13 years, 37% female, 43% aortic dissection). Outcomes of interest included in-hospital mortality; stroke; and spinal cord injury (SCI). In-hospital mortality rate was 11% (n = 43) overall, 9% (n = 15) for FET and 13% (n = 28) for ET. Post-operative stroke occurred in 13% (n = 49) overall, 13% (n = 22) for FET and 12% (n = 27) for ET. The rate of post-operative SCI was 3% (n = 13) overall, 5.0% (n = 9) for FET and 2.0% (n = 4) for ET. When compared to ET, the propensity score analysis confirmed FET to be associated with lower mortality (adjusted risk difference -7.0% (95% CI -13.0 to -1.0), P = 0.02). There was no significant difference in the propensity score-adjusted risk difference for stroke between FET and ET (-0.7%, 95% CI -7.4% to 6.1%, P = 0.85), nor for SCI (3.3%, 95% CI -0.4% to 7.0%, P = 0.085) On multivariable analysis, FET was associated with lower odds of mortality (OR 0.44, 95% CI 0.21–0.95, P = 0.04), and had similar odds of stroke (OR 0.83, 95% CI 0.41–1.70, P = 0.62) and SCI (OR 2.83, 95% CI 0.83–9.60, P = 0.1). FET repair is associated with lower in-hospital mortality as compared to conventional ET, and results in similar risk of stroke and spinal cord injury. Further investigation is warranted.
AB - To examine the perioperative outcomes following aortic arch repair using frozen elephant trunk (FET) vs conventional elephant trunk (ET) techniques. Between 2002 and 2018, 390 patients underwent aortic repair with elephant trunk reconstruction at 9 centers: 172 patients received a FET (mean age: 65+/-13 years, 30% female, 37% aortic dissection) and 218 patients received an ET (mean age: 63+/-13 years, 37% female, 43% aortic dissection). Outcomes of interest included in-hospital mortality; stroke; and spinal cord injury (SCI). In-hospital mortality rate was 11% (n = 43) overall, 9% (n = 15) for FET and 13% (n = 28) for ET. Post-operative stroke occurred in 13% (n = 49) overall, 13% (n = 22) for FET and 12% (n = 27) for ET. The rate of post-operative SCI was 3% (n = 13) overall, 5.0% (n = 9) for FET and 2.0% (n = 4) for ET. When compared to ET, the propensity score analysis confirmed FET to be associated with lower mortality (adjusted risk difference -7.0% (95% CI -13.0 to -1.0), P = 0.02). There was no significant difference in the propensity score-adjusted risk difference for stroke between FET and ET (-0.7%, 95% CI -7.4% to 6.1%, P = 0.85), nor for SCI (3.3%, 95% CI -0.4% to 7.0%, P = 0.085) On multivariable analysis, FET was associated with lower odds of mortality (OR 0.44, 95% CI 0.21–0.95, P = 0.04), and had similar odds of stroke (OR 0.83, 95% CI 0.41–1.70, P = 0.62) and SCI (OR 2.83, 95% CI 0.83–9.60, P = 0.1). FET repair is associated with lower in-hospital mortality as compared to conventional ET, and results in similar risk of stroke and spinal cord injury. Further investigation is warranted.
KW - Aortic arch repair
KW - Conventional elephant trunk
KW - Frozen elephant trunk
UR - http://www.scopus.com/inward/record.url?scp=85108566642&partnerID=8YFLogxK
U2 - 10.1053/j.semtcvs.2021.03.049
DO - 10.1053/j.semtcvs.2021.03.049
M3 - Article
C2 - 34089828
AN - SCOPUS:85108566642
SN - 1043-0679
VL - 34
SP - 386
EP - 392
JO - Seminars in Thoracic and Cardiovascular Surgery
JF - Seminars in Thoracic and Cardiovascular Surgery
IS - 2
ER -