Cinical results of L-and J-shaped minimally invasive approach in total arch replacement combined with frozen elephant trunk for acute type A aortic dissection
YANG Zhong-lu
LIU Yu
GE Yu-guang
JIANG Hui
Abstract：Objective To compare the clinical results of L-and J-shaped minimally invasive approach in total arch replacement(TAR)combined with frozen elephant trunk(FET)for acute type A aortic dissection(ATAAD).Methods A total of 74 consecutive patients with ATAAD who underwent TAR with FET implantation diagnosed by CTA between December 2019 and October 2020 in the General Hospital of the Northern Theater Command.There were 52 males and 22 females,aged(52.3±10.2)years old,ranging from 29 to 71 years old.Patients were divided into the J-group(n=43,surgery was performed between December 2019 and May 2020)and the L-group(n=31,surgery was performed between June 2020 and October 2020).In the J-group,J-shaped upper hemisternotomy was used,and L-shaped upper hemisternotomy was used in the L-group.The two groups were compared with the intraoperative variables level,arterial perfusion location,intraoperative surgical procedures,postoperative hospitalization,follow-up,and mortality.Results The cardiopulmonary bypass time,aortic blocking time,circulatory arrest time,minimum nasopharyngeal temperature,arterial perfusion location,(innominative artery,right subclavicular artery,right common carotid artery,left common carotid artery),surgical procedures(aortic suspension plasty,aortic valve replacement,Bentall,extracorporeal membrane oxygenation),ventilation time,ICU stay time,24 hours chest tube drainage,blood transfusion,reventilation,permanent neurological deficit,acute renal failure,postoperative hospitalization time and hospitalization cost was compared in two groups,the differences were not statistically significant(P＞0.05).The establishment time of cardiopulmonary bypass in J-group was shorter than that in L-group,the follow-up rate was lower than that in L-group,and the follow-up time was longer than that in L-group,the difference was statistically significant(P＜0.05).There was no significant difference in mortality between the two groups during treatment and follow-up(P＞0.05).Conclusions TAR with FET implantation is feasible and safely via J-shaped or L-shaped incision.The J-shaped incision might be beneficial for single incisions,and the time to establish cardiopulmonary bypass is shorter.
Keywords：Aortic dissectionTotal arch replacementMinimal invasive incisionHemisternotomyFrozen elephant trunk
Publication Date：2024-12-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 336-340 )