title: Modified frozen elephant trunk for acute type A aortic dissection: a comparative study with standard repair technique.
abstract: We hypothesized that antegrade open stent graft implantation in the descending aorta during acute type A aortic dissection surgery is safe and improves patient outcome compared with the standard repair technique.
  
  
  
  Hundred and forty-one consecutive patients underwent surgery for acute type A aortic dissection at our institution from 2010 to 2016. Of those, 104 patients underwent ascending aorta and hemiarch repair under hypothermic circulatory arrest with antegrade cerebral perfusion (standard group). Since 2013, 37 patients have undergone the standard procedure combined with antegrade stent implantation in the descending aorta (stented group). A matched analysis using the logistic EuroSCORE (37 patients per group) was done. All data were collected prospectively.
  
  
  
  The mean logistic EuroSCORE was 29 in both groups, P  =   1. Cardiopulmonary bypass time was 150 ± 57 (standard) vs 157 ± 48 (stented) min, P  =   0.6; aortic clamping 99 ± 47 (standard) vs 100 ± 36 (stented) min, P  =   1. Stented patients had longer circulatory arrest times with antegrade cerebral perfusion, 23 ± 7 vs 15 ± 7 min, P  <   0.001. Stroke occurred in 24.3% (standard) vs 8.1% (stented), P  =   0.1; paraplegia developed in 2.7% (standard) vs 0% (stented), P  =   1. Abdominal intervention due to suspected visceral ischaemia was needed in 18.9% (standard) vs 5.4% (stented), P  =   0.2. 30-day mortality was 13.5% (standard) vs 0% (stented), P  =   0.05. Survival at 6-month was 100% and 86.5% in patients with implanted stents and standard repair, respectively, P  =   0.02.
  
  
  
  Antegrade, open stent graft implantation into the descending aorta during acute type A aortic dissection repair is safe and is associated with improved outcomes at 6 months postoperatively compared to the standard repair technique.
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Matt
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Prerana
authors.initials: P
authors.lastname: Banerjee
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Grapow
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Rueter
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schurr
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Siegemund
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Jens
authors.initials: J
authors.lastname: Fassl
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Reuthebuch
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Eckstein
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
keywords: Dissection ; Endovascular ; Surgery