Association of long frozen elephant trunk and incidence of spinal cord injury in patients with acute type A aortic dissection: A single center retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Chaojie ^1,2,3 , ZHANG Wenqian ^3,4 , PENG Jihai ⁵ , CHEN Guangtian ¹ , GUO Haijiang ¹ , HONG Liang ¹ , HUANG Jinsong ¹ ,  FAN Xiaoping ²

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
2. Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510006, P. R. China;
3. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, P. R. China;
4. Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
5. Department of Rehabilitation, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;

Corresponding author：

FAN Xiaoping, Email: fukui-hanson@hotmail.com

Keywords：

Aortic dissection; elephant trunk; spinal cord injury

DOI：

10.7507/1007-4848.202011030

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Objective To evaluate whether long frozen elephant trunk (FET) increases the risk of spinal cord injury in patients with acute type A aortic dissection.Methods From 2018 to 2019, 172 patients with acute type A aortic dissection were treated in Guangdong Provincial People’s Hospital. They were divided into two groups according to the length of FET: patients treated with stents of 100 mm in length were enrolled into a short FET group, and those with stents of 150 mm in length into a long FET group. There were 124 patients in the short FET group, including 108 (87.1%) males and 16 (12.9%) females with a mean age of 51.8±7.9 years. There were 48 patients in the long FET group, including 44 (91.7%) males and 4 (8.3%) females with a mean age of 50.6±9.7 years. The clinical data and prognosis of the patients were analyzed.Results The mean distal stent graft was at the level of T 8.5±0.7 in the long FET group, and at the level of T 6.8±0.6 in the short FET group (P=0.001). Sixteen patients died after operation in the two groups, including 13 (10.5%) in the short FET group and 3 (6.2%) in the long FET group (P=0.561). There were 7 patients of spinal cord injury in the two groups, including 6 (4.8%) in the short FET group and 1 (2.2%) in the long FET group (P=0.675). There was no statistical difference in other complications between the two groups. The follow-up time was 16.7 (1-30) months. During the follow-up, 2 patients died in the long FET group and 5 died in the short FET group. No new spinal cord injury or distal reintervention occurred during the follow-up.Conclusion Long FET does not increase the incidence of spinal cord injury in patients with acute type A aortic dissection.

Citation： WANG Chaojie, ZHANG Wenqian, PENG Jihai, CHEN Guangtian, GUO Haijiang, HONG Liang, HUANG Jinsong, FAN Xiaoping. Association of long frozen elephant trunk and incidence of spinal cord injury in patients with acute type A aortic dissection: A single center retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1450-1454. doi: 10.7507/1007-4848.202011030 Copy

1.	Shrestha M, Bachet J, Bavaria J, et al. Current status and recommendations for use of the frozen elephant trunk technique: A position paper by the vascular domain of EACTS. Eur J Cardiothorac Surg, 2015, 47(5): 759-769.
2.	Shrestha M, Haverich A, Martens A. Total aortic arch replacement with the frozen elephant trunk procedure in acute DeBakey type Ⅰ aortic dissections. Eur J Cardiothorac Surg, 2017, 51(suppl 1): i29-i34.
3.	Leontyev S, Misfeld M, Daviewala P, et al. Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques—A single center study. Ann Cardiothorac Surg, 2013, 2(5): 606-611.
4.	Flores J, Kunihara T, Shiiya N, et al. Extensive deployment of the stented elephant trunk is associated with an increased risk of spinal cord injury. J Thorac Cardiovasc Surg, 2006, 131(2): 336-342.
5.	Hoffman A, Damberg ALM, Schälte G, et al. Thoracic stent graft sizing for frozen elephant trunk repair in acute type A dissection. J Thorac Cardiovasc Surg, 2013, 145(4): 964-969.
6.	Jakob H, Dohle DS, Piotrowski J, et al. Six-year experience with a hybrid stent graft prosthesis for extensive thoracic aortic disease: An interim balance. Eur J Cardiothorac Surg, 2012, 42(6): 1018-1025.
7.	Shrestha M, Beckmann E, Krueger H, et al. The elephant trunk is freezing: The Hannover experience. J Thorac Cardiovasc Surg, 2015, 149(5): 1286-1293.
8.	Iafrancesco M, Goebel N, Mascaro J, et al. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: Results from an international multicentre registry. Eur J Cardiothorac Surg, 2017, 52(2): 310-318.
9.	Sun L, Qi R, Chang Q, et al. Surgery for acute type A dissection with the tear in the descending aorta using a stented elephant trunk procedure. Ann Thorac Surg, 2009, 87(4): 1177-1180.
10.	Goldberg JB, Kim JB, Sundt TM. Current understandings and approach to the management of aortic intramural hematomas. Semin Thorac Cardiovasc Surg, 2014, 26(2): 123-131.
11.	Preventza O, Liao JL, Olive JK, et al. Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3 000 patients. J Thorac Cardiovasc Surg, 2020, 160(1): 20-33.
12.	Savader SJ, Williams GM, Trerotola SO, et al. Preoperative spinal artery localization and its relationship to postoperative neurologic complications. Radiology, 1993, 189(1): 165-171.
13.	Mizuno T, Toyama M, Tabuchi N, et al. Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg, 2002, 22(4): 504-509.
14.	Griepp EB, Di Luozzo G, Schray D, et al. The anatomy of the spinal cord collateral circulation. Ann Cardiothorac Surg, 2012, 1(3): 350-357.
15.	Zoli S, Roder F, Etz CD, et al. Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair. Ann Thorac Surg, 2010, 90(4): 1237-1244.
16.	Etz CD, Luehr M, Kari FA, et al. Paraplegia after extensive thoracic and thoracoabdominal aortic aneurysm repair: Does critical spinal cord ischemia occur postoperatively? J Thorac Cardiovasc Surg, 2008, 135(2): 324-330.
17.	Bischoff MS, Scheumann J, Brenner RM, et al. Staged approach prevents spinal cord injury in hybrid surgical-endovascular thoracoabdominal aortic aneurysm repair: An experimental model. Ann Thorac Surg, 2011, 92(1): 138-146.

1. Shrestha M, Bachet J, Bavaria J, et al. Current status and recommendations for use of the frozen elephant trunk technique: A position paper by the vascular domain of EACTS. Eur J Cardiothorac Surg, 2015, 47(5): 759-769.
2. Shrestha M, Haverich A, Martens A. Total aortic arch replacement with the frozen elephant trunk procedure in acute DeBakey type Ⅰ aortic dissections. Eur J Cardiothorac Surg, 2017, 51(suppl 1): i29-i34.
3. Leontyev S, Misfeld M, Daviewala P, et al. Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques—A single center study. Ann Cardiothorac Surg, 2013, 2(5): 606-611.
4. Flores J, Kunihara T, Shiiya N, et al. Extensive deployment of the stented elephant trunk is associated with an increased risk of spinal cord injury. J Thorac Cardiovasc Surg, 2006, 131(2): 336-342.
5. Hoffman A, Damberg ALM, Schälte G, et al. Thoracic stent graft sizing for frozen elephant trunk repair in acute type A dissection. J Thorac Cardiovasc Surg, 2013, 145(4): 964-969.
6. Jakob H, Dohle DS, Piotrowski J, et al. Six-year experience with a hybrid stent graft prosthesis for extensive thoracic aortic disease: An interim balance. Eur J Cardiothorac Surg, 2012, 42(6): 1018-1025.
7. Shrestha M, Beckmann E, Krueger H, et al. The elephant trunk is freezing: The Hannover experience. J Thorac Cardiovasc Surg, 2015, 149(5): 1286-1293.
8. Iafrancesco M, Goebel N, Mascaro J, et al. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: Results from an international multicentre registry. Eur J Cardiothorac Surg, 2017, 52(2): 310-318.
9. Sun L, Qi R, Chang Q, et al. Surgery for acute type A dissection with the tear in the descending aorta using a stented elephant trunk procedure. Ann Thorac Surg, 2009, 87(4): 1177-1180.
10. Goldberg JB, Kim JB, Sundt TM. Current understandings and approach to the management of aortic intramural hematomas. Semin Thorac Cardiovasc Surg, 2014, 26(2): 123-131.
11. Preventza O, Liao JL, Olive JK, et al. Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3 000 patients. J Thorac Cardiovasc Surg, 2020, 160(1): 20-33.
12. Savader SJ, Williams GM, Trerotola SO, et al. Preoperative spinal artery localization and its relationship to postoperative neurologic complications. Radiology, 1993, 189(1): 165-171.
13. Mizuno T, Toyama M, Tabuchi N, et al. Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg, 2002, 22(4): 504-509.
14. Griepp EB, Di Luozzo G, Schray D, et al. The anatomy of the spinal cord collateral circulation. Ann Cardiothorac Surg, 2012, 1(3): 350-357.
15. Zoli S, Roder F, Etz CD, et al. Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair. Ann Thorac Surg, 2010, 90(4): 1237-1244.
16. Etz CD, Luehr M, Kari FA, et al. Paraplegia after extensive thoracic and thoracoabdominal aortic aneurysm repair: Does critical spinal cord ischemia occur postoperatively? J Thorac Cardiovasc Surg, 2008, 135(2): 324-330.
17. Bischoff MS, Scheumann J, Brenner RM, et al. Staged approach prevents spinal cord injury in hybrid surgical-endovascular thoracoabdominal aortic aneurysm repair: An experimental model. Ann Thorac Surg, 2011, 92(1): 138-146.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Association of long frozen elephant trunk and incidence of spinal cord injury in patients with acute type A aortic dissection: A single center retrospective cohort study

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