• Kai Zhang, Juntao Qiu, Jinlin Wu, Chenyu Zhou, Yumeng Ji, Enzehua Xie, Shiqi Gao, Bin Hou, Han Li, Qian Chang, Xiangyang Qian, Xiaogang Sun, and Cuntao Yu.
• Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
• J. Thorac. Cardiovasc. Surg. 2024 Nov 26.

ObjectiveThe optimal surgical approach for acute type A aortic dissection involving the aortic arch remains controversial. This study aims to evaluate the long-term outcomes of acute type A aortic dissection treated with total arch replacement combined with frozen elephant trunk implantation in a large single-center cohort.MethodsFrom 2010 to 2022, patients with acute type A aortic dissection who received total arch replacement with frozen elephant trunk implantation at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Logistic regression and Cox regression analyses were performed to identify risk factors for operative mortality, long-term mortality, and reoperation.ResultsA total of 1672 patients underwent total arch replacement with frozen elephant trunk implantation, of whom 79.9% (1336/1672) were male with a median age of 48 years. The operative mortality rate was 6.3% (105/1672). The 10-year survival was 81.4%, and the most extended follow-up was over 13 years. Among the survivors, 89.7% (1303/1453) had complete self-care ability and were able to engage in general physical work. The 10-year cumulative incidence of reoperation was 13.3%. Multivariable logistic regression analysis revealed that male gender was associated with a reduced risk of operative death (odds ratio, 0.95, 95% CI, 0.92-0.98) and long-term death (hazard ratio, 0.68, 95% CI, 0.48-0.96).ConclusionsTotal arch replacement with frozen elephant trunk implantation demonstrates acceptable operative mortality and promising long-term outcomes for acute type A aortic dissection. Female patients face higher risks of operative and long-term mortality compared with male patients. Total arch replacement with frozen elephant trunk implantation provides patients with encouraging long-term quality of life and is advisable for acute type A aortic dissection in experienced centers.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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