Abstract
BACKGROUND: Total arch replacement with frozen elephant trunk has achieved promising outcomes for DeBakey type I aortic dissection. However, the effects of anticoagulation on the distal false lumen and unfavorable remodeling of the distal aorta after aortic valve replacement remains insufficiently understood. This study aimed to assess the impact of anticoagulation following aortic valve replacement on medium and long-term vascular remodeling outcomes in DeBakey type I aortic dissection. METHODS: We conducted a retrospective analysis of patients who underwent total arch replacement with a frozen elephant trunk for DeBakey Type I aortic dissection from September 2013 to December 2024. Seventy-two patients with preoperative and at least six months postoperative aortic computed tomography angiography images were included and stratified into a valve replacement group (n = 30) and a non-valve replacement group (n = 42). Various parameters of the residual dissected aorta were analyzed at six specific levels to evaluate late aortic remodeling, aortic diameter, and false lumen thrombosis. RESULTS: The median follow-up period was 17 (interquartile range IQR = 9-27) months. Preoperative characteristics and complications did not significantly differ between the two groups, except for body mass index, blood pressure, and severity of aortic regurgitation. The valve replacement group had longer cardiopulmonary bypass time, aortic cross-clamping time, cardiac arrest time, larger trunk diameter, and higher intraoperative red blood cells transfusion volume compared to the non-valve replacement group. However, there were no statistically significant differences in concomitant procedures, postoperative complications, or length of hospital stay. Regarding postoperative changes in the diameter of aortic lumen and true lumen, there were statistically significant difference in the true lumen on level 1 and the aortic lumen on level 3-5 of the valve replacement group. Additionally, the aortic lumen and true lumen on level 1 and true lumen on level 2 of the non-valve replacement group were statistically difference. There were no significant differences in the rate of aortic remodeling at each level or overall between the two groups. The postoperative false lumen thrombosis rate was higher in the mid-descending thoracic aorta and lower in the distal abdominal aorta. CONCLUSIONS: Anticoagulation following aortic valve replacement for Debakey I aortic dissection has been shown to influence aortic diameter and the false lumen thrombosis rate, but it does not significantly affect the aortic remodeling rate. Overall, anticoagulation appears to be a viable treatment strategy for Debakey I aortic dissection.