Risk factors for distal stent graft-induced new entry after frozen elephant trunk procedure in chronic aortic dissection.

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

General Thoracic and Cardiovascular Surgery Pub Date : 2025-02-06 DOI:10.1007/s11748-025-02122-5

Sho Akita, Yoshiyuki Tokuda, Yuji Narita, Sachie Terazawa, Tomo Yoshizumi, Hideki Ito, Masato Mutsuga

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Abstract

Background: The frozen elephant trunk (FET) procedure has emerged as an effective single-stage treatment for complex aortic pathologies. However, it carries a risk of distal stent graft-induced new entry (dSINE) in patients with chronic aortic dissection (CAD). This study investigated risk factors associated with dSINE development.

Methods: Between 2009 and 2021, 160 FET procedures were performed, including 48 cases of CAD (mean time from onset: 5.6 ± 3.8 years). After excluding five patients due to incomplete 6-month postoperative computed tomography (CT) data, 43 patients were included. A multivariable stepwise Cox proportional hazards regression analysis was conducted to identify predictors of dSINE.

Results: During a mean follow-up period of 5.9 ± 3.9 years, dSINE occurred in 22 of 43 patients (51.1%). Univariate analysis identified three significant risk factors for dSINE: total aortic diameter (TAD) > 45 mm at the distal stent-graft level (HR 5.88, 95% CI 1.35-25.52, p = 0.018), True lumen (TL) perimeter-based diameter (HR 1.22, 95% CI 1.03-1.46; p = 0.021), and TL ovality (HR 1.31, 95% CI 1.04-1.65, p = 0.022). Multivariate analysis revealed TAD > 45 mm as an independent risk factor for dSINE (HR 4.60, 95% CI 1.01-20.85, p = 0.048). The 5-year freedom from dSINE was significantly higher in patients with TAD ≤ 45 mm compared to those with TAD > 45 mm (87.5% vs. 20.8%, p < 0.01).

Conclusions: Although FET remains an important therapeutic option for CAD, dSINE represents a significant postoperative complication. TAD > 45 mm was identified as an independent risk factor. These findings may guide surgical planning for FET procedures.

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慢性主动脉夹层冷冻象鼻手术后远端支架移植诱导新血管进入的危险因素。

背景：冷冻象鼻（FET）手术已成为复杂主动脉病变的一种有效的单阶段治疗方法。然而，对于慢性主动脉夹层（CAD）患者，它存在远端支架移植诱导的新进入（dsin）的风险。本研究调查了与dine发展相关的危险因素。方法：2009年至2021年间，共进行了160例FET手术，其中包括48例CAD（平均发病时间：5.6±3.8年）。由于术后6个月计算机断层扫描（CT）数据不完整，排除5例患者后，纳入43例患者。采用多变量逐步Cox比例风险回归分析确定dsin的预测因子。结果：在平均5.9±3.9年的随访期间，43例患者中有22例（51.1%）发生了dsin。单因素分析确定了dcine的三个重要危险因素：远端支架水平的主动脉总直径（TAD） bbbb45 mm (HR 5.88, 95% CI 1.35-25.52, p = 0.018)，真管腔（TL）周长直径(HR 1.22, 95% CI 1.03-1.46；p = 0.021)和TL值（HR 1.31, 95% CI 1.04-1.65, p = 0.022）。多因素分析显示TAD bbb45 mm是dsin的独立危险因素（HR 4.60, 95% CI 1.01-20.85, p = 0.048）。与TAD小于45 mm的患者相比，TAD小于45 mm的患者5年的dsin自由度明显更高（87.5% vs. 20.8%, p）。结论：尽管FET仍然是CAD的重要治疗选择，但dsin是一个重要的术后并发症。TAD bbbb45 mm被确定为独立危险因素。这些发现可以指导FET手术的手术计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

General Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine

CiteScore

2.70

自引率

8.30%

发文量

142

期刊介绍： The General Thoracic and Cardiovascular Surgery is the official publication of The Japanese Association for Thoracic Surgery and The Japanese Association for Chest Surgery, the affiliated journal of The Japanese Society for Cardiovascular Surgery, that publishes clinical and experimental studies in fields related to thoracic and cardiovascular surgery.