Vol. 27 No. 3 (2023)
CORONARY ARTERY DISEASES

False lumen thrombosis and aneurysmal transformation of the non-operated aorta after surgical treatment of proximal dissection

pdf (Русский)
  • A.M. Chernyavskiy,
  • M.M. Lyashenko,
  • D.A. Sirota,
  • A.A. Shadanov,
  • B.N. Kozlov,
  • D.S. Panfilov,
  • E.V. Skurikhina
A.M. Chernyavskiy
Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk
M.M. Lyashenko
Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk
Bio
D.A. Sirota
Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk
A.A. Shadanov
Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk
B.N. Kozlov
Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
D.S. Panfilov
Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
E.V. Skurikhina
Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk
DOI: https://doi.org/10.21688/1681-3472-2023-3-19-30

Published 2023-09-29

Keywords

  • Aorta, Thoracic,
  • Aortic Dissection,
  • Blood Vessel Prosthesis Implantation,
  • Retrospective Studies,
  • Thrombosis

How to Cite

Chernyavskiy, A., Lyashenko, M., Sirota, D., Shadanov, A., Kozlov, B., Panfilov, D., & Skurikhina, E. (2023). False lumen thrombosis and aneurysmal transformation of the non-operated aorta after surgical treatment of proximal dissection. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 27(3), 19–30. https://doi.org/10.21688/1681-3472-2023-3-19-30

Copyright (c) 2023 Chernyavskiy A.M., Lyashenko M.M., Sirota D.A., Shadanov A.A., Kozlov B.N., Panfilov D.S., Skurikhina E.V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Background: One of the most feared long-term complications of surgical treatment of proximal aortic dissections is an aneurysm of the non-operated compartments of the aorta.
Objective: To conduct a comparative analysis of different methods for surgical treatment of proximal aortic dissections in relation to false lumen thrombosis development in non-operated compartments.
Methods: We conducted a simple observational retrospective multicenter study to study the effectiveness of the frozen elephant trunk technique compared with a standard surgical intervention (aggressive hemiarch anastomosis or total aortic arch replacement with a multibranched prosthesis). Our study included 101 patients grouped based on the method of treatment: group 1 for frozen elephant trunk (n = 31); group 2 for thoracic aorta reconstruction by the standard methods (control group, n = 70). Due to the retrospective nature of the study and the disparity of groups by certain characteristics, we used propensity score matching to increase the reliability of the results. All patient data were collected in the preoperative period, from the protocols of surgical interventions, in the postoperative and long-term periods (3-6 months, 1 year, 2 years, 3 years after surgery). All statistical calculations were conducted in the RStudio software, version 0.99.879 (RStudio Inc., Boston, USA).
Results: The absence of false lumen thrombosis at the thoracic aorta level persisted after the surgical treatment in half of the patients in the control group (n = 13; 52%) and was not determined in the frozen elephant trunk group. Complete false lumen thrombosis at the thoracic aorta level (level of stent graft placement and distal to the diaphragm) was achieved in more than half of the patients in the frozen elephant trunk group and only in 3 (12%) control patients. Aneurysmal transformation of the non-operated aorta occurred in 12 (48%) patients from group 2 and was absent in group 1.
Conclusion: The frozen elephant trunk technique reduces the frequency of aorto-related events to 0% within 3 years compared with the standard approach (32%, P < .005). Patients operated on for proximal aortic dissection using the frozen elephant trunk technique are significantly more likely to have false lumen thrombosis in the thoracic aorta (P = .004), significantly lower incidence of aneurysmal transformation or thoracic aorta growth rate of >5 mm per year in the long-term period (P = .016) compared with those who underwent the standard methods.

Received 15 February 2023. Revised 31 July 2023. Accepted 4 August 2023.

Funding: The study was carried out within the framework of the grant of the President of the Russian Federation НШ-5096.2022.3 (agreement No. 075-15-2022-823 dated 12.05.2022).

Conflict of interest: The authors declare no conflict of interest.

Contribution of the authors
Conception and study design: A.M. Chernyavskiy, M.M. Lyashenko
Data collection and analysis: M.M. Lyashenko, A.A. Shadanov, D.S. Panfilov, E.V. Skurikhina
Statistical analysis: M.M. Lyashenko
Drafting the article: M.M. Lyashenko
Critical revision of the article: A.M. Chernyavskiy, D.A. Sirota, B.N. Kozlov
Final approval of the version to be published: A.M. Chernyavskiy, M.M. Lyashenko, D.A. Sirota, A.A. Shadanov, B.N. Kozlov, D.S. Panfilov, E.V. Skurikhina

pdf (Русский)

References

  1. Гордеев М.Л., Успенский В.Е., Баканов А.Ю., Волков В.В., Ибрагимов А.Н., Щербинин Т.С., Иртюга О.Б., Наймушин А.В. Реконструктивные вмешательства на дуге аорты при хирургическом лечении аневризм и расслоений восходящего отдела аорты. Патология кровообращения и кардиохирургия. 2016;20(4):45-57. https://doi.org/10.21688/1681-3472-2016-4-45-57 Gordeev M.L., Uspenskiy V.E., Bakanov A.Yu., Volkov V.V., Ibragimov A.N., Scherbinin T.S., Irtyuga O.B., Naimushin A.V. Aortic arch reconstruction in surgical treatment of ascending aortic aneurysms and dissections. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2016;20(4):45-57. (In Russ.) https://doi.org/10.21688/1681-3472-2016-4-45-57
  2. Sayed A., Munir M., Bahbah E.I. Aortic dissection: a review of the pathophysiology, management and prospective advances. Curr Cardiol Rev. 2021;17(4):e230421186875. PMID: 33059568. PMCID: PMC8762162. https://doi.org/10.2174/1573403X16666201014142930
  3. Evangelista A., Isselbacher E.M., Bossone E., Gleason T.G., Di Eusanio M., Sechtem U., Ehrlich M.P., Trimarchi S., Braverman A.C., Myrmel T., Harris K.M., Hutchinson S., O'Gara P., Suzuki T., Nienaber C.A., Eagle K.A.; IRAD Investigators. Insights from the International Registry of Acute Aortic Dissection: a 20-year experience of collaborative clinical research. Circulation. 2018;137(17):1846-1860. PMID: 29685932. https://doi.org/10.1161/CIRCULATIONAHA.117.031264
  4. Erbel R., Aboyans V., Boileau C., Bossone E., Bartolomeo R.D., Eggebrecht H., Evangelista A., Falk V., Frank H., Gaemperli O., Grabenwöger M., Haverich A., Iung B., Manolis A.J., Meijboom F., Nienaber C.A., Roffi M., Rousseau H., Sechtem U., Sirnes P.A., Allmen R.S., Vrints C.J.; ESC Committee for Practice Guidelines. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873-2926. PMID: 25173340. https://doi.org/10.1093/eurheartj/ehu281
  5. Rosinski B.F., Idrees J.J., Roselli E.E., Germano E., Pasadyn S.R., Lowry A.M., Blackstone E.H., Johnston D.R., Soltesz E.G., Navia J.L., Desai M.Y., Mick S.L., Bakaeen F.G., Svensson L.G. Cannulation strategies in acute type A dissection repair: a systematic axillary artery approach. J Thorac Cardiovasc Surg. 2019;158(3):647-659.e645. PMID: 30770117. https://doi.org/10.1016/j.jtcvs.2018.11.137
  6. Ghoreishi M., Sundt T.M., Cameron D.E., Holmes S.D., Roselli E.E., Pasrija C., Gammie J.S., Patel H.J., Bavaria J.E., Svensson L.G., Taylor B.S. Factors associated with acute stroke after type A aortic dissection repair: an analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg. 2020;159(6):2143-2154.e2143. PMID: 31351776. https://doi.org/10.1016/j.jtcvs.2019.06.016
  7. Moizumi Y., Motoyoshi N., Sakuma K., Yoshida S. Axillary artery cannulation improves operative results for acute type A aortic dissection. Ann Thorac Surg. 2005;80(1):77-83. PMID: 15975344. https://doi.org/10.1016/j.athoracsur.2005.01.058
  8. Jormalainen M., Raivio P., Mustonen C., Honkanen H.-P., Vento A., Biancari F., Juvonen T. Direct aortic versus peripheral arterial cannulation in surgery for type A aortic dissection. Ann Thorac Surg. 2020;110(4):1251-1258. PMID: 32165179. https://doi.org/10.1016/j.athoracsur.2020.02.010
  9. Bonser R.S., Ranasinghe A.M., Loubani M., Evans J.D., Thalji N.M.A., Bachet J.E., Carrel T.P., Czerny M., Di Bartolomeo R., Grabenwöger M., Lonn L., Mestres C.A., Schepens M.A.A.M., Weigang E. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol. 2011;58(24):2455-2474. PMID: 22133845. https://doi.org/10.1016/j.jacc.2011.06.067
  10. Di Eusanio M., Trimarchi S., Peterson M.D., Myrmel T., Hughes G.C., Korach A., Sundt T.M., Di Bartolomeo R., Greason K., Khoynezhad A., Appoo J.J., Folesani G., De Vincentiis C., Montgomery D.G., Isselbacher E.M., Eagle K.A., Nienaber C.A., Patel H.J. Root replacement surgery versus more conservative management during type A acute aortic dissection repair. Ann Thorac Surg. 2014;98(6):2078-2084. PMID: 25282163. https://doi.org/10.1016/j.athoracsur.2014.06.070
  11. Yang B., Norton E.L., Hobbs R., Farhat L., Wu X., Hornsby W.E., Kim K.M., Patel H.J., Deeb G.M. Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: twenty-year experience. J Thorac Cardiovasc Surg. 2019;157(6):2125-2136. PMID: 30737109; PMCID: PMC6588514. https://doi.org/10.1016/j.jtcvs.2018.09.129
  12. Tokunaga C., Kumagai Y., Chubachi F., Hori Y., Takazawa A., Hayashi J., Asakura T., Ishii R., Nakajima H., Yoshitake A. Total arch replacement using frozen elephant trunk technique with Frozenix for distal aortic arch aneurysms. Interact Cardiovasc Thorac Surg. 2022;35(1):ivac038. PMID: 35179581; PMCID: PMC9252127. https://doi.org/10.1093/icvts/ivac038
  13. Poon S.S., Theologou T., Harrington D., Kuduvalli M., Oo A., Field M. Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2016;5(2):156-173. PMID: 27386403; PMCID: PMC4893527. https://doi.org/10.21037/acs.2016.05.06
  14. Kamman A.V., Yang B., Kim K.M., Williams D.M., Michael Deeb G., Patel H.J. Visceral malperfusion in aortic dissection: the Michigan experience. Semin Thorac Cardiovasc Surg. 2017;29(2):173-178. PMID: 28823323. https://doi.org/10.1053/j.semtcvs.2016.10.002
  15. Merkle J., Sabashnikov A., Deppe A.-C., Zeriouh M., Maier J., Weber C., Eghbalzadeh K., Schlachtenberger G., Shostak O., Djordjevic I., Kuhn E., Rahmanian P.B., Madershahian N., Rustenbach C., Liakopoulos O., Choi Y.-H., Kuhn-Régnier F., Wahlers T. Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection. Ther Adv Cardiovasc Dis. 2018;12(12):327-340. PMID: 30295137; PMCID: PMC6266246. https://doi.org/10.1177/1753944718801568
  16. Leontyev S., Haag F., Davierwala P.M., Lehmkuhl L., Borger M.A., Etz C.D., Misfeld M., Gutberlet M., Mohr F.W. Postoperative changes in the distal residual aorta after surgery for acute type A aortic dissection: impact of false lumen patency and size of descending aorta. Thorac Cardiovasc Surg. 2017;65(2):90-98. PMID: 27111499. https://doi.org/10.1055/s-0036-1571813
  17. Borst H.G., Walterbusch G., Schaps D. Extensive aortic replacement using “elephant trunk” prosthesis. Thorac Cardiovasc Surg. 1983;31(1):37-40. PMID: 6189250. https://doi.org/10.1055/s-2007-1020290
  18. Dapunt O.E., Galla J.D., Sadeghi A.M., Lansman S.L., Mezrow C.K., de Asla R.A., Quintana C., Wallenstein S., Ergin A.M., Griepp R.B. The natural history of thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 1994;107(5):1323-1332. PMID: 8176976.
  19. Kato M., Ohnishi K., Kaneko M., Ueda T., Kishi D., Mizushima T., Matsuda H. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation. 1996;94(9 Suppl):II188-193. PMID: 8901744.
  20. Suto Y., Yasuda K., Shiiya N., Murashita T., Kawasaki M., Imamura M., Takigami K., Sasaki S., Matsui Y., Sakuma M. Stented elephant trunk procedure for an extensive aneurysm involving distal aortic arch and descending aorta. J Thorac Cardiovasc Surg. 1996;112(5):1389-1390. PMID: 8911340. https://doi.org/10.1016/S0022-5223(96)70157-5
  21. Shrestha M., Kaufeld T., Beckmann E., Fleissner F., Umminger J., Abd Alhadi F., Boethig D., Krueger H., Haverich A., Martens A. Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: single-center results of the first 100 patients. J Thorac Cardiovasc Surg. 2016;152(1):148-159.e1. PMID: 27167026. https://doi.org/10.1016/j.jtcvs.2016.02.077
  22. Чернявский А.М., Ляшенко М.М., Сирота Д.А., Хван Д.С., Козлов Б.Н., Панфилов Д.С., Лукинов В.Л. Гибридные технологии при хирургическом лечении проксимальных расслоений аорты. Российский кардиологический журнал. 2018;(11):8-13. https://doi.org/10.15829/1560-4071-2018-11-8-13 Chernyavsky A.M., Lyashenko M.M., Syrota D.A., Khvan D.S., Kozlov B.N., Panfilov D.S., Lukinov V.L. Hybrid technology in the surgical treatment of proximal aortic dissection. Russian Journal of Cardiology. 2018;(11):8-13. (In Russ.) https://doi.org/10.15829/1560-4071-2018-11-8-13
  23. Hiratzka L.F., Bakris G.L., Beckman J.A., Bersin R.M., Carr V.F., Casey D.E. Jr, Eagle K.A., Hermann L.K., Isselbacher E.M., Kazerooni E.A., Kouchoukos N.T., Lytle B.W., Milewicz D.M., Reich D.L., Sen S., Shinn J.A., Svensson L.G., Williams D.M.; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13):e266-369. PMID: 20233780. https://doi.org/10.1161/CIR.0b013e3181d4739e
  24. Tan M.E.S.H., Morshuis W.J., Dossche K.M.E., Kelder J.C., Waanders F.G.J., Schepens M.A.A.M. Long-term results after 27 years of surgical treatment of acute type A aortic dissection. Ann Thorac Surg. 2005;80(2):523-529. PMID: 16039197. https://doi.org/10.1016/j.athoracsur.2005.02.059
  25. Ma W.-G., Chen Y., Zhang W., Li Q., Li J.-R., Zheng J., Liu Y.-M., Zhu J.-M., Sun L.-Z. Extended repair for acute type A aortic dissection: long-term outcomes of the frozen elephant trunk technique beyond 10 years. J Cardiovasc Surg (Torino). 2020;61(3):292-300. PMID: 32077675.