Objective: The optimal surgical approach for acute type A aortic dissection (ATAAD) involving the aortic arch remains controversial. This study aims to evaluate the long-term outcomes of ATAAD treated with total arch replacement combined with frozen elephant trunk implantation (TAR with FET) in a large single-center cohort.
Methods: From 2010 to 2022, ATAAD patients who received TAR with FET at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Logistic regression and Cox regression analyses were performed to identify risk factors for operative mortality, long-term mortality, and reoperation, respectively.
Results: A total of 1672 patients underwent TAR with FET, of whom 79.9% (1336/1672) were male with a median age of 48 years. The operative mortality rate was 6.3% (105/1672). The 10-year survival rate was 81.4%, and the most extended follow-up was over 13 years. Among the survivors, 89.7% (1303/1453) had complete self-care ability and were able to engage in general physical work. The 10-year cumulative incidence of reoperation was 13.3%. Multivariable logistic regression analysis revealed that male gender was associated with a reduced risk of operative death (odds ratio 0.95, 95% confidence interval 0.92-0.98) and long-term death (hazard ratio 0.68, 95% confidence interval 0.48-0.96).
Conclusions: TAR with FET demonstrates acceptable operative mortality and promising long-term outcomes for ATAAD. Females face higher risks of operative and long-term mortality compared to males. TAR with FET provides patients with encouraging long-term quality of life and is advisable for ATAAD in experienced centers.
Keywords: acute aortic dissection; aortic surgery; long-term outcomes; total arch replacement.
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