Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Dissection Repair

Background:

• Acute type A aortic dissection (ATAAD) presents significant surgical challenges.
• The frozen elephant trunk (FET) and partial remodeling (PR) techniques are advanced surgical options.
• Long-term outcomes of combined FET and PR for ATAAD require detailed evaluation.

Purpose of the Study:

• To describe the frozen elephant trunk (FET) technique and partial remodeling (PR) for ATAAD.
• To evaluate the long-term prognosis of patients undergoing FET and PR for ATAAD.
• To assess the efficacy of these combined techniques over a 13-year period.

Main Methods:

• Retrospective analysis of 80 consecutive ATAAD patients (September 1997-February 2010).
• Application of PR for all patients; FET for selected cases based on distal entry, arch dilatation, or true lumen size.
• Surgical procedure involved moderate hypothermic circulatory arrest, selective cerebral/distal perfusion, and stent graft insertion, followed by total arch replacement and either sinotubular junction plication or cusp remodeling.

Main Results:

• In-hospital mortality was 5% (4 patients); early morbidity included 2.5% strokes, with no spinal cord injury.
• Long-term follow-up (mean 94.6 months) showed 5 non-aortic deaths and 2 re-operations.
• No false lumen patency or residual aortic regurgitation was observed on late CT/echogram. 10-year survival was 75%, with a 95% 10-year re-operation-free rate for the thoracic aorta.

Conclusions:

• The FET technique combined with modified PR is effective for managing ATAAD.
• These surgical approaches improve long-term outcomes for both proximal and distal aorta in ATAAD patients.
• The study supports the use of FET and PR for favorable long-term prognosis in ATAAD.