Experience with the conventional and frozen elephant trunk techniques: a single-centre study

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Disease
• Aortic Arch Replacement

Background:

• The elephant trunk procedure is standard for extensive thoracic aortic disease.
• Comparing conventional elephant trunk (cET) and frozen elephant trunk (FET) techniques is crucial for optimizing patient outcomes.

Purpose of the Study:

• To retrospectively analyze and compare the outcomes of cET versus FET operations.
• To identify risk factors for mortality, stroke, and spinal cord injury in patients undergoing these procedures.

Main Methods:

• Retrospective analysis of 171 patients undergoing total aortic arch replacement between 2003-2011.
• Comparison of outcomes between cET (n=125) and FET (n=46) techniques.
• Analysis of patient demographics, indications for surgery, and perioperative complications.

Main Results:

• In-hospital mortality was 21.6% for cET and 8.7% for FET (P=0.1).
• New-onset paraplegia was significantly higher in the FET group (21.7% vs 4.0%, P<0.001).
• Type A aortic dissection was an independent predictor of mortality and stroke; axillary cannulation was protective against stroke.

Conclusions:

• FET is associated with acceptable mortality but higher spinal cord injury rates compared to cET.
• cET may be preferable for prolonged circulatory arrest, especially under moderate hypothermia.
• Axillary cannulation improves neurological outcomes; Type A dissection is a risk factor for adverse outcomes.