Clinical Efficacy Analysis Of Aortic Arch Fenestrated Stent In The Treatment Of Acute Stanford Type A Aortic Dissectio

Objective:This study aims to analyse the clinical efficacy and applicable population of fenestration stent(FS)in the treatment of acute Stanford type A aortic dissection,total arch replacement with frozen elephant trunk(TAR)is used as reference.Methods:A total of 834 patients with acute Stanford type A aortic dissection and underwent FS(N=507)or TAR(N=327)surgery in our center from January 2015 to December 2021 were retrospectively analyzed.Using propensity score matching to balance differences between two groups.The early-and mid-term outcomes of both groups before and after matching were analyzed and compared.Using Logistic regression model to analyze the independent risk factors for in-hospital death and the population characteristics of patients who had benefited from FS.Results:Compared with TAR group,FS group had shorter operation time,less blood transfusion requirement,shorter mechanical ventilation and hospital stay(all P<0.05).Propensity score matching analysis showed that the FS group had lower in-hospital mortality(7.2%vs.12.6%,P=0.023)and mechanical ventilation>48 hours rate(21.2%vs.34.9%,P<0.001).The incidence of postoperative acute kidney injury(30.6%vs.37.8%,P=0.045)and paraplegia(0.4%vs.2.9%,P=0.038)in FS group were lower,but the incidence of postoperative stroke was higher(9.0%vs.5.0%,P=0.097).No significant difference was showed at the overall survival rates and overall free from reoperation rate between two groups.FS was independent protective factors of in-hospital death(OR 0.482,95%CI 0.283-0.820,P=0.007)and was associated with reduced in-hospital mortality in patients whose age was over 60,without preoperative pericardial tamponade,coronary artery and intestinal malperfusion,as well as patients who used dual arterial cannulation strategy(femoral+axillary artery)(all P<0.05).Conclusion:FS can effectively simplify the operation and shorten the postoperative recovery time of patients with acute Stanford type A aortic dissection.FS is a safer method for aortic arch repair in patients over 60 years of age,without preoperative pericardial tamponade,coronary artery and intestinal malperfusion.Dual arterial cannulation strategy is favour.However,FS may be associated with an increased risk of postoperative stroke,and it is necessary to choose the appropriate cannulation and cerebral perfusion strategies.