title: Frozen elephant trunk with total arch replacement for type A aortic dissections: Does acuity affect operative mortality?
abstract: OBJECTIVE
  We seek to compare the early outcomes of frozen elephant trunk with total aortic arch replacement using a 4-branched graft (the Sun procedure) in patients with acute and chronic type A aortic dissection (TAAD), identify the risk factors for operative mortality, and determine whether the acuity of TAAD significantly affects operative mortality.
  
  
  METHODS
  We performed univariate and multivariate analyses of the clinical data from 803 patients with TAAD who underwent the Sun procedure.
  
  
  RESULTS
  The operative mortality was 6.5% (52 of 803). The overall incidence of stroke and spinal cord injury was 2.0% (16 of 803) and 2.4% (19 of 803), respectively. Patients with acute TAAD had a greater incidence of operative death (8.1% vs 4.3%; P = .031), stroke (2.2% vs 0.6%; P = .046), and respiratory morbidities (20.8% vs 8.6%; P < .001). However, acuity was not identified as a risk factor for operative mortality (odds ratio [OR], 1.67; P = .152). The risk factors were previous cerebrovascular disease (OR, 7.01; P = .001); malperfusion of the brain (OR, 7.10; P = .002), kidneys (OR, 12.67; P = .005), spinal cord (OR, 22.79; P = .008), and viscera (OR 22.98; P = .002); concomitant extra-anatomic bypass (OR, 9.50; P < .001); and cardiopulmonary bypass time >180 minutes (OR, 1.01; P < .001).
  
  
  CONCLUSIONS
  In this group of patients with type A dissection, acuity was not a risk factor for operative mortality after the Sun procedure. Patients with previous cerebrovascular disease; malperfusion of the brain, kidneys, spinal cord, and/or viscera; concomitant extra-anatomic bypass; and a longer cardiopulmonary bypass time (>180 minutes) were at greater risk of operative mortality.
authors.affiliation: Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China; Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn.
authors.forename: Wei-Guo
authors.initials: WG
authors.lastname: Ma
authors.affiliation: Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Sun
authors.affiliation: Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn.
authors.forename: Bulat A
authors.initials: BA
authors.lastname: Ziganshin
authors.affiliation: Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
authors.forename: Long-Fei
authors.initials: LF
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China.
authors.forename: Rui-Dong
authors.initials: RD
authors.lastname: Qi
authors.affiliation: Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China.
authors.forename: Yong-Min
authors.initials: YM
authors.lastname: Liu
authors.affiliation: Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China.
authors.forename: Jun-Ming
authors.initials: JM
authors.lastname: Zhu
authors.affiliation: Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Chang
authors.affiliation: Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn.
authors.forename: John A
authors.initials: JA
authors.lastname: Elefteriades
authors.affiliation: Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Beijing, China. Electronic address: lizhongsun@outlook.com.
authors.forename: Li-Zhong
authors.initials: LZ
authors.lastname: Sun
mesh_terms: D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome