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Updated: Dec 29, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Decision-making at initial surgery for type A aortic dissection in patients with Marfan syndrome: proximal or
Ning Li1, Yu Zhang1, Yuan Gao1
1Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Background:
Data on outcome of Stanford type A aortic dissection (TAAD) in Marfan syndrome (MFS) patients are limited. We investigated the full spectrum of reoperation and survival after initial surgery in MFS patients who suffered TAAD.
Methods:
Retrospective analysis of 85 consecutive MFS patients in one-single center during the past 15 years.
Results:
Overall, 85 MFS patients with TAAD underwent surgical repair [74% acute dissections; 80% DeBakey type I; 91% composite valved graft; 70% total arch replacement (TAR); 68% frozen elephant trunk (FET); 7% in-hospital mortality] at Changhai hospital affiliated to the Second Military Medical University over the past 15 years. Five (20.8%) patients in non-TAR group need aortic arch reintervention with resternotomy during follow-up, which is significantly higher than that in TAR group (P=0.001). Freedom from aortic arch reoperation in non-TAR group was all 78.7%±8.5% at 5, 10, and 15 years. No patient required aortic arch reoperation in TAR group (P=0.001). On the other hand, the FET was inserted into false lumen intentionally at initial surgery in 2 cases of chronic TAAD with narrowed true lumen. Scheduled thoracoabdominal aortic replacement was performed 6 months later. Both 2 patients are with well clinical outcomes. At last, we found that Debakey type and TAR at initial surgery were irrelevant to survival and reoperation for descending aorta.
Conclusions:
TAR combined with FET is recommended in MFS patients when the aortic arch is dissected or enlarged. The FET could be inserted into the false lumen intentionally in selective case for scheduled 2-staged descending aortic repair.
Insights
Total arch replacement with frozen elephant trunk is recommended for Marfan syndrome patients with aortic dissection. This approach significantly reduces reoperation rates for aortic arch issues.
Area of Science:
- Cardiovascular Surgery
- Genetics
- Aortic Diseases
Background:
- Limited data exists on the outcomes of Stanford type A aortic dissection (TAAD) in Marfan syndrome (MFS) patients.
- Investigating reoperation and survival after initial surgery in MFS patients with TAAD is crucial.
Purpose of the Study:
- To investigate the full spectrum of reoperation and survival after initial surgery in Marfan syndrome patients who suffered Stanford type A aortic dissection.
Main Methods:
- Retrospective analysis of 85 consecutive Marfan syndrome patients with TAAD over 15 years.
- Surgical repair including total arch replacement (TAR) and frozen elephant trunk (FET) implantation.
Main Results:
- 70% of patients underwent total arch replacement (TAR), and 68% received a frozen elephant trunk (FET).
- Patients who did not undergo TAR required significantly more aortic arch reinterventions (20.8%) compared to those who did (P=0.001).
- No patient in the TAR group required aortic arch reoperation.
Conclusions:
- Total arch replacement (TAR) combined with frozen elephant trunk (FET) is recommended for Marfan syndrome patients with aortic dissection or enlargement of the aortic arch.
- Intentional insertion of FET into the false lumen can be considered for scheduled two-stage descending aortic repair in selected cases.
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