Clinical effects of type Ⅱ hybrid aortic arch repair for type A aortic dissection in elderly and non-elderly patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIU Jiawei , ZHAO Rui , WANG De , WU Jinlin , QIU Juntao , JIANG Wenxiang , DAI Lu , XIE Enzehua , FAN Shuya , GAO Wei , CAO Fangfang , HOU Bin ,  YU Cuntao

Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

YU Cuntao, Email: cuntaoyu@126.com

Keywords：

Hybrid aortic arch repair; type A aortic dissection; total aortic arch replacement; surgery

DOI：

10.7507/1007-4848.201911001

Video：

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Objective To discuss the efficacy of type Ⅱ hybrid aortic arch repair for type A aortic dissection in patients of different age groups.Methods We retrospectively analyzed the clinical data of 126 patients with type A aortic dissection admitted to the Fuwai Hospital between January 2016 and December 2018, including 78 (61.9%) males and 48 (38.1%) females, with an average age of 61.8±6.9 years. The patients were divided into an elderly group (≥60 years, n=82) and a non-elderly group (<60 years, n=44). The preoperative, intraoperative and postoperative data of patients in the two groups were compared.Results The age between the elderly and non-elderly group was significantly different (65.9±4.1 years vs. 54.3±4.1 years, P<0.010), and no significant difference was found between the two groups in other preoperative baseline data. There were 6 (4.8%) patients of early death, 3 (2.4%) patients of stroke and 2 (1.6%) patients of paralysis. A total of 194 stents were implanted, and the average dimeter of the stents was 33.6±1.8 mm and the average length was 199.0±6.7 mm. The non-elderly group had shorter mechanical ventilation time (31.9±41.7 h vs. 61.0±89.2 h, P=0.043) and ICU stay time (77.8±51.4 h vs. 143.1±114.4 h, P<0.001) than the elderly group. There was no significant difference in in-hospital mortality rate, reoperation rate or survival rate between the two groups (P>0.05). Follow-up time was 1-43 (22.6±10.8) months, and 3 patients were lost. There were 104 (82.5%) patients of complete thrombus formation of false lumen in stent and endoleak was reported in 11 (9.2%) patients.Conclusion Type Ⅱ hybrid aortic arch repair offers an alternative approach to acute type A aortic dissection with acceptable early and mid-term clinical effects. The non-elderly patients have a similar early treatment effect to the elderly patients, but have a better mid-term outcome.

Citation： QIU Jiawei, ZHAO Rui, WANG De, WU Jinlin, QIU Juntao, JIANG Wenxiang, DAI Lu, XIE Enzehua, FAN Shuya, GAO Wei, CAO Fangfang, HOU Bin, YU Cuntao. Clinical effects of type Ⅱ hybrid aortic arch repair for type A aortic dissection in elderly and non-elderly patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1010-1014. doi: 10.7507/1007-4848.201911001 Copy

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2.	Howard DP, Banerjee A, Fairhead JF, <italic>et al</italic>. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford vascular study. Circulation, 2013, 127(20): 2031-2037.
3.	Fann JI, Smith JA, Miller DC, <italic>et al</italic>. Surgical management of aortic dissection during a 30-year period. Circulation, 1995, 92(9 Suppl): I113-I121.
4.	Hagan PG, Nienaber CA, Isselbacher EM, <italic>et al</italic>. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
5.	Scholl FG, Coady MA, Davies R, <italic>et al</italic>. Interval or permanent nonoperative management of acute type A aortic dissection. Arch Surg, 1999, 134(4): 402-405.
6.	柳枫, 孙立忠, 常谦, 等. 应用象鼻技术治疗主动脉疾病的疗效及随访观察. 中国循环杂志, 2002, 17(6): 428-429.
7.	孙立忠, 刘志刚, 常谦, 等. 主动脉弓替换加支架“象鼻”手术治疗 Stanford A 型主动脉夹层. 中华外科杂志, 2004, 42(13): 47-51.
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10.	Hofferberth SC, Newcomb AE, Yii MY, <italic>et al</italic>. Hybrid proximal surgery plus adjunctive retrograde endovascular repair in acute DeBakey typeⅠdissection: superior outcomes to conventional surgical repair. J Thorac Cardiovasc Surg, 2013, 145(2): 349-354.
11.	Preventza O, Garcia A, Cooley DA, <italic>et al</italic>. Total aortic arch replacement: A comparative study of zone 0 hybrid arch exclusion versus traditional open repair. J Thorac Cardiovasc Surg, 2015, 150(6): 1591-1598.
12.	Settepani F, Cappai A, Basciu A, <italic>et al</italic>. Outcome of open total arch replacement in the modern era. J Vasc Surg, 2016, 63(2): 537-545.
13.	Oda T, Minatoya K, Sasaki H, <italic>et al</italic>. Is conventional open repair still a good option for aortic arch aneurysm in patients of advanced age? Ann Thorac Surg, 2016, 101(1): 80-86.
14.	Kent WD, Appoo JJ, Bavaria JE, <italic>et al</italic>. Results of typeⅡhybrid arch repair with zone 0 stent graft deployment for complex aortic arch pathology. J Thorac Cardiovasc Surg, 2014, 148(6): 2951-2955.
15.	Uchida N, Shibamura H, Katayama A, <italic>et al</italic>. Operative strategy for acute type A aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg, 2009, 87(3): 773-777.
16.	Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2): 149-159.
17.	Vallabhajosyula P, Szeto W, Desai N, <italic>et al</italic>. Type Ⅰ and type Ⅱ hybrid aortic arch replacement: postoperative and mid-term outcome analysis. Ann Cardiothorac Surg, 2013, 2(3): 280-287.
18.	Faure EM, Canaud L, Agostini C, <italic>et al</italic>. Reintervention after thoracic endovascular aortic repair of complicated aortic dissection. J Vasc Surg, 2014, 59(2): 327-333.
19.	Geisbüsch P, Kotelis D, Müller-Eschner M, <italic>et al</italic>. Complications after aortic arch hybrid repair. J Vasc Surg, 2011, 53(4): 935-941.
20.	Moulakakis KG, Mylonas SN, Markatis F, <italic>et al</italic>. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg, 2013, 2(3): 247-260.
21.	王冕, 常光其, 殷恒讳, 等. 杂交技术治疗主动脉弓部病变的经验分析. 中华外科杂志, 2015, 53(11): 826-830.
22.	Joo HC, Youn YN, Kim JH, <italic>et al</italic>. Conventional open versus hybrid arch repair of aortic arch disease: Early and long-term outcomes. Ann Thorac Surg, 2019, 107(5): 1380-1388.
23.	Hiraoka A, Chikazawa G, Totsugawa T, <italic>et al</italic>. Objective analysis of midterm outcomes of conventional and hybrid aortic arch repair by propensity-score matching. J Thorac Cardiovasc Surg, 2017, 154(1): 100-106.
24.	Tokuda Y, Oshima H, Narita Y, <italic>et al</italic>. Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. Eur J Cardiothorac Surg, 2016, 49(1): 149-156.

1. Olsson C, Thelin S, Ståhle E, <italic>et al</italic>. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation, 2006, 114(24): 2611-2618.
2. Howard DP, Banerjee A, Fairhead JF, <italic>et al</italic>. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford vascular study. Circulation, 2013, 127(20): 2031-2037.
3. Fann JI, Smith JA, Miller DC, <italic>et al</italic>. Surgical management of aortic dissection during a 30-year period. Circulation, 1995, 92(9 Suppl): I113-I121.
4. Hagan PG, Nienaber CA, Isselbacher EM, <italic>et al</italic>. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
5. Scholl FG, Coady MA, Davies R, <italic>et al</italic>. Interval or permanent nonoperative management of acute type A aortic dissection. Arch Surg, 1999, 134(4): 402-405.
6. 柳枫, 孙立忠, 常谦, 等. 应用象鼻技术治疗主动脉疾病的疗效及随访观察. 中国循环杂志, 2002, 17(6): 428-429.
7. 孙立忠, 刘志刚, 常谦, 等. 主动脉弓替换加支架“象鼻”手术治疗 Stanford A 型主动脉夹层. 中华外科杂志, 2004, 42(13): 47-51.
8. Saleh HM, Inglese L. Combined surgical and endovascular treatment of aortic arch aneurysms. J Vasc Surg, 2006, 44(3): 460-466.
9. Weigang E, Parker J, Czerny M, <italic>et al</italic>. Endovascular aortic arch repair after aortic arch de-branching. Ann Thorac Surg, 2009, 87(2): 603-607.
10. Hofferberth SC, Newcomb AE, Yii MY, <italic>et al</italic>. Hybrid proximal surgery plus adjunctive retrograde endovascular repair in acute DeBakey typeⅠdissection: superior outcomes to conventional surgical repair. J Thorac Cardiovasc Surg, 2013, 145(2): 349-354.
11. Preventza O, Garcia A, Cooley DA, <italic>et al</italic>. Total aortic arch replacement: A comparative study of zone 0 hybrid arch exclusion versus traditional open repair. J Thorac Cardiovasc Surg, 2015, 150(6): 1591-1598.
12. Settepani F, Cappai A, Basciu A, <italic>et al</italic>. Outcome of open total arch replacement in the modern era. J Vasc Surg, 2016, 63(2): 537-545.
13. Oda T, Minatoya K, Sasaki H, <italic>et al</italic>. Is conventional open repair still a good option for aortic arch aneurysm in patients of advanced age? Ann Thorac Surg, 2016, 101(1): 80-86.
14. Kent WD, Appoo JJ, Bavaria JE, <italic>et al</italic>. Results of typeⅡhybrid arch repair with zone 0 stent graft deployment for complex aortic arch pathology. J Thorac Cardiovasc Surg, 2014, 148(6): 2951-2955.
15. Uchida N, Shibamura H, Katayama A, <italic>et al</italic>. Operative strategy for acute type A aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg, 2009, 87(3): 773-777.
16. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2): 149-159.
17. Vallabhajosyula P, Szeto W, Desai N, <italic>et al</italic>. Type Ⅰ and type Ⅱ hybrid aortic arch replacement: postoperative and mid-term outcome analysis. Ann Cardiothorac Surg, 2013, 2(3): 280-287.
18. Faure EM, Canaud L, Agostini C, <italic>et al</italic>. Reintervention after thoracic endovascular aortic repair of complicated aortic dissection. J Vasc Surg, 2014, 59(2): 327-333.
19. Geisbüsch P, Kotelis D, Müller-Eschner M, <italic>et al</italic>. Complications after aortic arch hybrid repair. J Vasc Surg, 2011, 53(4): 935-941.
20. Moulakakis KG, Mylonas SN, Markatis F, <italic>et al</italic>. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg, 2013, 2(3): 247-260.
21. 王冕, 常光其, 殷恒讳, 等. 杂交技术治疗主动脉弓部病变的经验分析. 中华外科杂志, 2015, 53(11): 826-830.
22. Joo HC, Youn YN, Kim JH, <italic>et al</italic>. Conventional open versus hybrid arch repair of aortic arch disease: Early and long-term outcomes. Ann Thorac Surg, 2019, 107(5): 1380-1388.
23. Hiraoka A, Chikazawa G, Totsugawa T, <italic>et al</italic>. Objective analysis of midterm outcomes of conventional and hybrid aortic arch repair by propensity-score matching. J Thorac Cardiovasc Surg, 2017, 154(1): 100-106.
24. Tokuda Y, Oshima H, Narita Y, <italic>et al</italic>. Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. Eur J Cardiothorac Surg, 2016, 49(1): 149-156.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effects of type Ⅱ hybrid aortic arch repair for type A aortic dissection in elderly and non-elderly patients

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