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Efficacy of Total Aortic Arch Replacement Combined with Frozen Elephant Trunk in Aortic Reoperation

Guanglong Sun, Lizhong Sun, Junming Zhu, Yongmin Liu, Yipeng Ge, Shijun Xu

(Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland))

Med Sci Monit 2019; 25:3998-4004

DOI: 10.12659/MSM.916938


BACKGROUND: The aim of this study was to estimate the long-term efficacy of total aortic arch replacement combined with the frozen elephant trunk (TAR+FET) technique for aortic disease following a prior cardiac surgery procedure.
MATERIAL AND METHODS: We performed TAR+FET for 118 patients for major vessel disease following a prior cardiac procedure with median sternotomy incision. All patients were divided into 5 groups: in group A, the prior major procedure was aortic valve replacement (AVR); in group B, the prior major procedure was isolated ascending aorta replacement; in group C, the prior major procedure was aortic root replacement; in group D, the prior major procedure was aortic arch replacement or intervention; and in group E, the prior major procedure was ‘other’ cardiac operative procedure. The long-term follow-up visit results were estimated using the Kaplan-Meier method.
RESULTS: The 30-day mortality rate after the operation was 13.6% (16/118) - 2 died in group A, 1 in group B, 8 in group C, 4 in group D, and 1 in group E. Follow-up visits were completed in 99% of patients. The mean follow-up time was 47.6±36.3 months and 12 patients had died by follow-up, so the total long-term survival rate was 76.3%. One-year survival rates of the 5 groups were 85% (group A), 93.8% (group B), 82.3% (group C), 50% (group D), and 50% (group E), respectively. Five-year survival rates of the 5 groups were 85%, 93.8%, 80.6%, 50%, and 50%, respectively.
CONCLUSIONS: The TAR+FET technique is feasible and efficacious for aortic reoperation in patients who previously underwent cardiac surgery since the short-term mortality in patients with recurrent aortic arch disease after cardiac surgery is not high.

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