Visceral malperfusion after Frozen Elephant Trunk in chronic aortic dissection: post-operative predictors and outcomes. (15th July 2021)

• Record Type: Journal Article
• Authors: Mariani, Carlo; Botta, Luca; Leone, Alessandro; Murana, Giacomo; Berardi, Marianna; Coppola, Giuditta; Amodio, Ciro; Buia, Francesco; Di Marco, Luca; Pacini, Davide
• Is Part Of: International journal of cardiology. Volume 335(2021)
• Page Start: 26
• Page End: 31
• Publication Date: 2021-07-15
• Subjects: MPS malperfusion syndrome -- FET frozen elephant trunk -- TL true lumen -- FL false lumen -- dSINE distal stent graft induced new entry -- CBP cardio-pulmonary bypass -- ASCP antegrade selective cerebral perfusion -- CFS Cerebral Fluid Spine -- CTA computer tomography angiogram -- CT Coeliac Trunk -- SMA Superior Mesenteric artery -- RRA Right renal artery -- LRA Left renal arteriy -- SCAR supracoronary ascending aortic replacement; Aortic Dissection -- Bowel -- Frozen Elephant Trunk -- Malperfusion -- Renal -- Visceral; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.04.004
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The aims of this study were to analyse the incidence of visceral malperfusion syndrome (MPS) following Frozen Elephant trunk operations in patients affected by chronic aortic dissection and the associated risk factors. Methods: Between January 2007 and February 2019, 165 patients underwent surgery with FET for chronic aortic dissection. Post-operative computer tomography angiogram parameters (diameters, early post-operative false lumen enhancement and involving of aortic branches by the dissection) were collected and analysed to evaluate their impact on the occurrence of visceral malperfusion. Results: Visceral (renal and mesenteric) MPS (with both clinical and radiological signs of MPS) was detected in 10 cases (6.1%). Post-operative visceral malperfusion was strongly related with in hospital mortality. The involvement of the visceral branches in the dissection was not a risk factor for visceral malperfusion occurrence, while a larger post-operative total aortic diameter at level of the coeliac trunk increased the risk of visceral MPS (OR 1.05; CI 1.002–1.102, p -value = 0.04). Furthermore, visceral MPS was associated to a complete thrombosis of the false lumen at level of the distal descending thoracic aorta. Conclusions: The development of post-operative MPS in frozen elephant trunk is strongly related to in-hospital mortality. The involvement of aortic branches by the dissection does not represent a real predictive risk factor for MPS, while early larger aortic diameters and false lumen thrombosis represent independent risk factors for MPS and in-hospital mortality. Graphical abstract: Unlabelled Image Highlights: Post-operative malperfusion after frozen elephant trunk surgery significantly affects in-hospital mortality. The involvement of aortic branches by the dissection does not represent a real predictive risk factor for malperfusion. Larger diameters at level of the descending aorta and false lumen thrombosis are risk factors for malperfusion and early mortality.