title: Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period.
abstract: OBJECTIVE
  To evaluate the efficacy of the frozen elephant trunk (FET) and total arch replacement (TAR) technique (FET + TAR) in the management of type A aortic dissection (TAAD) with arch entry tear.
  
  
  METHODS
  Clinical outcomes were analyzed for 104 TAAD patients with arch entry tear undergoing FET + TAR at 4.7 ± 3.5 days from symptom onset and compared with 728 TAAD patients with entry tears in elsewhere. The mean patient age was 49.3 ± 9.3 years, compared with 45.6 ± 10.8 years in other TAAD patients (P < .001). There were 84 men (80.8%). Hypertension was seen in 84.6% (88/104).
  
  
  RESULTS
  Operative mortality was 8.6% (9/104). Spinal cord injury occurred in 3 cases (2.9%), stroke in 2 (1.9%), renal failure in 4 (3.8%) and limb ischemia in 2 (1.9%). Follow-up was 100% (95/95) at mean 5.6 ± 2.6 years (range 1.3-11.6). Late death occurred in 2 cases (1.9%). Survival and freedom from late adverse events were 89.2% (95% confidence interval [CI], 81.3%-93.9%) and 85.0% (95% CI, 76.3%-90.8%) at 8 years, respectively. Both the stented and unstented distal aortic segments showed significant trends of false lumen shrinkage and true lumen expansion over time (P < .001). Of the 65 CT scans at mean 4.6 ± 2.9 years postoperatively, the false lumen was completely obliterated in 63. Risk factors for arch entry tear were hypertension (odds ratio [OR], 2.091; 95% CI, 1.186-3.687; P = .011) and age (OR, 1.025; 95% CI, 1.002-1.048; P = .032).
  
  
  CONCLUSIONS
  TAAD with arch entry tear was treated safely and durably by FET + TAR. Although patients with arch entry tear were somewhat older than other patients, operative mortality was not substantially higher despite their older age and arch location of entry tear. These results argue favorably for the use of the FET + TAR technique in the management of TAAD patients with arch entry tears.
authors: 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, Beijing, China; Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn.
authors: Wei-Guo
authors: WG
authors: Ma
authors: 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: Wei
authors: W
authors: Zhang
authors: 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: Long-Fei
authors: LF
authors: Wang
authors: 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, Beijing, China.
authors: Jun
authors: J
authors: Zheng
authors: Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn.
authors: Bulat A
authors: BA
authors: Ziganshin
authors: Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn.
authors: Paris
authors: P
authors: Charilaou
authors: 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, Beijing, China.
authors: Xu-Dong
authors: XD
authors: Pan
authors: 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, Beijing, China.
authors: Yong-Min
authors: YM
authors: Liu
authors: 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, Beijing, China.
authors: Jun-Ming
authors: JM
authors: Zhu
authors: Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China.
authors: Qian
authors: Q
authors: Chang
authors: Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn; Department of Economics, Stony Brook University, Stony Brook, NY; Department of Preventive Medicine, Stony Brook University, Stony Brook, NY.
authors: John A
authors: JA
authors: Rizzo
authors: Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Conn.
authors: John A
authors: JA
authors: Elefteriades
authors: 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, Beijing, China. Electronic address: lizhongsun@outlook.com.
authors: Li-Zhong
authors: LZ
authors: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000473:pathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods*; D055815:Young Adult
keywords: Kaplan-Meier estimate; aorta; aortic dissection; blood vessel prosthesis; mortality; thoracic/surgery; treatment outcome