| OBJECTIVE:In this study,patients with acute DeBakey type I aortic dissection underwent either the classic Sun’s procedure or the single fenestrated frozen elephant trunk(FET)technique,and the perioperative and follow-up data of patients were compared and analyzed to assess the clinical efficacy of the single fenestrated frozen elephant trunk technique,with the aim of providing a new option to simplify the surgical treatment of acute DeBakey type Ⅰ aortic dissection.METHODS:This was a single-center retrospective study that included 44 patients diagnosed with acute DeBakey type I aortic dissection and treated surgically by the same chief surgeon from January 2022 to January 2023,who were divided into the fenestration group and the classic Sun’s procedure group according to the surgical approach.Statistical methods such as nonparametric rank sum test and chi-square test were used to compare and analyze the differences between the two groups in preoperative baseline data,intraoperative data,postoperative data,and follow-up data.RESULTS:The median age of all patients was 55 years,of which 14 were female and 30 were male.Comparison of baseline data showed that there were no significant differences between the two groups in baseline data such as basic characteristics,underlying diseases and preoperative laboratory results,except for the history of alcohol consumption(P=0.028)and the occurrence of consciousness disorder before admission(P=0.019).Intraoperative data showed a median operative duration of 432.50 minutes;a median extracorporeal circulation duration of 217.00 minutes;a median aortic clamp duration of 125.00 minutes;a median moderate hypothermic circulatory arrest duration of 25.00 minutes;and a median auxiliary circulation duration of 68.50 minutes in all patients.The median intraoperative red blood cell transfusion volume was 4.00 U;the median plasma transfusion volume was 400.00 mL.Comparison of intraoperative data showed that,except for the significant difference in the length of auxiliary circulation(P=0.008),there were no significant differences between the two groups in the choice of aortic root procedure,the choice of extracorporeal circulation cannula location,the cerebral protection strategy during circulatory arrest,the duration of several surgery-related operations,and the intraoperative transfusion of blood products.The postoperative data showed that the median total length of stay for all patients was 13.00 days;the median length of postoperative mechanical ventilation was 20.00 hours;and the median length of postoperative ICU stay was 90.00 hours.Among all patients,there were 9 early postoperative deaths,and the cause of death was multi-organ dysfunction in all cases.Comparison of the postoperative data showed that,except for the significant difference in the total length of hospital stay(P=0.042),there were no significant differences between the two groups in terms of the length of postoperative mechanical ventilation,length of ICU stay,volume of drainage,complication rate,and operative mortality.Follow-up data showed that patients were followed up for a median of 9.00 months after discharge,with no deaths.All follow-up patients were in generally good condition,with no hoarseness,paraparesis or paraplegia.The follow-up radiologic data showed that one patient in the fenestration group had a complete occlusion of the left subclavian artery(LSCA)and one case of the fenestration group had a limited endoleak at the fenestration of the LSCA,while the rest had no significant abnormalities.The distal end of the stent graft was located at the level of the 7th or 8th thoracic vertebra in all follow-up patients,with significant aortic false lumen thrombosis distal to the stent graft.CONCLUSION:The single fenestrated frozen elephant trunk technique is a simple and feasible technique to treat acute DeBakey type I aortic dissection,with definite short-term efficacy,but the medium-and long-term efficacy need to be verified by further follow-up. |
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