Key result
Frozen elephant trunk using the MedEng graft compared with the E-vita OP graft resulted in similar early mortality and mid-term survival.
Why the study?
Various hybrid grafts with significantly different features are used for the frozen elephant trunk technique, but their comparative early- and mid-term outcomes in aortic dissection were unclear.
Does the MedEng hybrid graft improve early- and mid-term mortality compared to the E-vita open plus graft in patients undergoing frozen elephant trunk for aortic dissection?
RCT (n=45)
randomized
Does the MedEng hybrid graft improve early- and mid-term mortality compared to the E-vita open plus graft in patients undergoing frozen elephant trunk for aortic dissection?
In patients undergoing frozen elephant trunk for aortic dissection, the use of MedEng versus E-vita OP hybrid grafts resulted in comparable early mortality and morbidity, with a non-significant trend toward better mid-term survival with the MedEng graft.
Answers are grounded in this paper and cite their sources.
Comparable early outcomes support either graft in small cohorts; leaves open optimal selection pending larger trials.
Background. The frozen elephant trunk technique has become popular and led to an expansion of indications for surgery. Various hybrid grafts for the frozen elephant trunk are used, sometimes with significantly different features. The objective of this study was to compare early- and mid-term outcomes after the frozen elephant trunk for aortic dissection using different hybrid grafts. Methods. The prospective study included 45 patients with acute/chronic aortic dissections. The patients were randomized into two groups. Group 1 patients (n = 19) were implanted with a hybrid graft E-vita open plus (E-vita OP). Group 2 (n = 26) included patients who received a MedEng graft. The inclusion criteria were type A and type B acute and chronic aortic dissection. The exclusion criteria were as follows: hyperacute aortic dissection (less than 24 h), organ malperfusion, oncology, severe heart failure, stroke, and acute myocardial infarction. The primary endpoint was early- and mid-term mortality. The secondary endpoints were postoperative complications (stroke and spinal cord ischemia, myocardial infarction, respiratory failure, acute renal injury, and re-operation for bleeding). Results. The rate of stroke and spinal cord ischemia in the E-vita OP vs. MedEng groups was 11% vs. 4% (p = 0.565) and 11% vs. 0% (p = 0.173), respectively. The respiratory failure rate was comparable in both groups (p > 0.999). Acute kidney injury requiring hemodialysis and the need for re-sternotomy in the MedEng group vs. E-vita OP group was 31% vs. 16% (p = 0.309) and 15% vs. none (p = 0.126), respectively. Early mortality in the MedEng and E-vita OP groups did not differ (8% vs. 0, p = 0.501). The mid-term survival in the analyzed groups was 79% vs. 61%, (p = 0.079), respectively. Conclusions. No statistically significant differences were observed between patients receiving frozen elephant trunk with the hybrid MedEng and E-vita OP grafts in regard to early mortality and morbidity. Mid-term survival was also non-significant between analyzed groups with a trend toward more favorable mortality in the MedEng group.
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Козлов et al. (2023) conducted an RCT in acute/chronic aortic dissections (n=45). MedEng graft vs. E-vita open plus (E-vita OP) graft was evaluated on early mortality (p=0.501). Frozen elephant trunk using the MedEng graft compared with the E-vita OP graft resulted in similar early mortality and mid-term survival.
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