Key result
Total arch replacement with a stented elephant trunk yielded a higher 5-year freedom from aortic arch events compared to hemiarch replacement (100% vs 83.7%, P=0.01).
Why the study?
To determine the efficacy of total arch replacement with stented elephant trunk compared with hemiarch replacement with and without open stent graft for acute aortic dissection type 1.
Does total arch replacement with stented elephant trunk improve false lumen thrombosis and prevent arch events compared to hemiarch replacement in patients with acute type 1 aortic dissection?
Cohort (n=275)
Does total arch replacement with stented elephant trunk improve false lumen thrombosis and prevent arch events compared to hemiarch replacement in patients with acute type 1 aortic dissection?
Total arch replacement with a stented elephant trunk significantly improves false lumen thrombosis and reduces 5-year arch events compared to hemiarch replacement in acute type 1 aortic dissection.
May favor total arch with stented elephant trunk to reduce arch events in acute type A dissection; leaves open need for randomized confirmation.
Objective We aimed to determine the efficacy of total arch replacement with stented elephant trunk by comparing it with hemiarch replacement with and without open stent graft for acute aortic dissection type 1. Methods We reviewed records of 177 patients who underwent hemiarch replacement (HAR group) (concomitant open stent, 125) and 98 patients who underwent total arch replacement (TAR group) (concomitant stented elephant trunk, 91) for acute type 1 dissection. Compared with the TAR group, the HAR group was older (68.1 vs 60.9 years; P < .01) and had more thrombosed false lumen (28.8% vs 4.1%, P < .01). Results In-hospital death occurred for 7 patients in the HAR group and 1 patient in the TAR group ( P = .17). More patients in the TAR group had a postoperative thrombosed false lumen, compared with the HAR group (68% vs 54%, P = .03). In patients with preoperative nonthrombosed false lumen in the HAR group, the rate of postoperative thrombosis was significantly lower than with versus without an open stent (31% vs 65%, P = .01). The rate of freedom from an aortic arch event in the TAR group at 5 years was significantly greater than that in the HAR group (100% vs 83.7%, P = .01). Conclusions Stented elephant trunk with TAR provided a high rate of false lumen thrombosis and a low incidence of arch events, whereas an open stent during HAR was not beneficial in terms of false lumen thrombosis and arch event prevention.
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Hayashi et al. (2022) conducted a cohort in Acute type 1 aortic dissection (n=275). Total arch replacement with stented elephant trunk vs. Hemiarch replacement with or without open stent graft was evaluated on Freedom from an aortic arch event at 5 years (p=0.01). Total arch replacement with a stented elephant trunk yielded a higher 5-year freedom from aortic arch events compared to hemiarch replacement (100% vs 83.7%, P=0.01).
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