RESULTS
Between December 2017 and May 2020, 70 consecutive patients (mean age
62.7±10.6 years, 84% male) underwent FET for arch and thoracic aorta
pathologies, 41 (58.6%) acute aortic dissections (AAD) and 29 (41.6%)
chronic pathologies: ascending aorta/aortic arch aneurysm (An) in 19
(24.3%) and chronic type I dissection (CAD) in 10 (14.2%). The
distributions of baseline characteristics for the overall population are
presented in Table 1. Twelve (17.1%) patients had already undergone
cardiac surgery. Fifteen AAD patients (36.5%) presented with peripheral
malperfusion. There were no significant differences in terms of age,
gender and other preoperative comorbidities between the groups. The only
significant difference was previous cardiac surgery (redo) (4.9% in
emergency group vs. 34.5% in elective group, P<0.01) Patients
presenting in emergency setting had a higher incidence of malperfusion
but this difference did not reach statistical significance.
No intraoperative deaths were recorded. Operative characteristics and
their distributions among the two groups are showed in Table 2.
Concomitant procedures were required in 36 (51.4%) patients: 12
(17.1%) coronary artery bypass grafting, 10 (14.3%) aortic valve
replacement, 14 aortic root surgery such as 9 (12.9%) Florida sleeve
procedures and 5 (7.1%) modified Bentall. There was a statistically
significant difference between the two groups in terms of
cardiopulmonary bypass time (212.9±42.7 minutes in the emergency group
vs. 175.5±51.1 minutes in the elective group, P<0.01) and
aortic cross clamp time (123.8±38.9 minutes in the emergency group vs.
87.1±31.9 in the elective group, P< 0.01). The mean deep
hypothermic circulatory arrest time was 30.6±6 minutes and did not
differ among the two groups.
Postoperative outcomes are summarized in Table 3. Thirty-day mortality
was 10.0% (n=7) for the entire cohort of patients (12.1% in emergency
vs. 6.8% in chronic settings, P=0.421). Cumulative in-hospital
mortality was 14.2% (n=12, 17.1% in emergency vs. 10.3% in chronic
settings, P=0.312). No differences were found in terms of postoperative
CVA (mRS 5/6, 2.4% in the emergency group vs. 0% in the elective
group, P=1), SCI with paraplegia (2.4% in the emergency group vs. 0%
in the elective group, P=1) and AKI requiring hemodialysis (31.7% in
the emergency group vs. 20.7% in the elective group, P=0.454). The
incidence of respiratory failure requiring tracheostomy did not differ
between the two groups (31.7% vs 24.1%, P=0.673).
The final multivariable Cox proportional hazard model showed that higher
LVEF (HR, 0.93; 95% CI 0.88—0.99; P=0.03) was a protective factor for
mid-term survival, while cerebral malperfusion at presentation (HR,
4.42; 95% CI, 1.19—16.33; P=0.03) and aortic cross-clamp time (HR,
1.01; 95% CI, 1—1.02; P=0.05) were found to be independent predictor
factors affecting mid-term survival. Emergency surgery did not
significantly impact on long-term survival (elective HR, 0.60; 95% CI,
0.21–1.7; P=0.33).
There were no aortic re-interventions in either group. Five patients
with residual type B dissection underwent TEVAR successful completion of
repair which was performed at least 6 weeks after the primary operation
in order to reduce the spinal cord ischemia risk. There was no dSINE and
no intraluminal thrombosis.
Median follow-up was 12.5 months (IQR 3.9—22.3). Overall survival for
the entire cohort at 3 months, 6 months, 12 months and 24 months was
90% (95% CI, 83.2—97.3), 85.6% (95% CI, 77.7—94.3), 79.1% (95%
CI, 69.9—89.5), 75.6% (95% CI, 65.8—86.9) and 73.5 (95% CI,
63.3—85.3), respectively (Figure 3). Survival rate by group were
85.2% vs. 86.1% at 3 months, 77.3% vs. 82.2% at 6 months, 71.7% vs.
82.2% at 12 months and 68.6% vs. 82.2% at 24 months, all emergency
vs. elective, respectively (Figure 4).