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Morphometric Predictors of Aortic Remodeling after Frozen Elephant Trunk Repair of Type A Dissection

Published:January 29, 2022DOI:https://doi.org/10.1016/j.avsg.2022.01.007

      HIGHLIGHTS

      • Aortic (Ao) remodeling after frozen elephant trunk (FET) surgery is important.
      • We analyzed the morphometric predictors for Ao remodeling.
      • The predictors were the true lumen/Ao area ratio and the shape of the true lumen.
      • Quantification of the true lumen shape can predict Ao remodeling after FET surgery.

      Background

      We analyzed the predictors of postoperative aortic remodeling after the frozen elephant trunk technique for type A dissection.

      Methods

      This retrospective study cohort comprised 20 patients who underwent the frozen elephant trunk technique for type A dissection. The incidence of aortic remodeling was evaluated at 4 levels: middle of the frozen elephant trunk, distal end of the frozen elephant trunk, 10th thoracic vertebra, and proximal to the celiac artery. Several parameters of the residual dissected aorta were analyzed at these 4 levels, and the predictors of aortic remodeling were investigated.

      Results

      The incidence of aortic remodeling was 85% at the middle of the frozen elephant trunk, 70% at the distal end of the frozen elephant trunk, 50% at the 10th thoracic vertebra, and 35% proximal to the celiac artery. In a total of 80 computed tomography images, there were significant differences between the aortic remodeling and nonremodeling groups in the true lumen diameter, false lumen diameter, true lumen/aortic diameter ratio, true lumen area, true lumen/aortic area ratio, and 2 parameters explaining the shape of the true lumen (created using elliptic Fourier analysis). Multivariate analysis revealed that the independent predictors of aortic remodeling were the true lumen/aortic area ratio and principal component 1.

      Conclusions

      There were high incidences of aortic remodeling at the middle and distal end of the frozen elephant trunk. Multivariate analysis showed that the true lumen/aorta area ratio and the shape of the true lumen may be important predictors of aortic remodeling.

      Keywords

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