The frozen elephant trunk technique for retrograde acute type A aortic dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Operative strategies for retrograde acute type A aortic dissection with primary intimal tears are challenging due to difficulties in resecting intimal tears via median sternotomy.
• The frozen elephant trunk technique is an alternative approach for managing complex aortic dissections.

Purpose of the Study:

• To evaluate the efficacy and outcomes of the frozen elephant trunk technique in treating acute retrograde type A aortic dissection with a primary intimal tear in the descending aorta.

Main Methods:

• The frozen elephant trunk technique was applied to 25 consecutive patients with acute retrograde type A aortic dissection and primary intimal tear.
• Patient demographics, preoperative conditions (including Marfan syndrome, lower body ischemia, stroke, coronary ischemia, pericardial tamponade), and follow-up data were collected.

Main Results:

• No hospital deaths occurred. Postoperative complications included stroke and mediastinitis in 2 patients.
• Median follow-up was 58 months, with 2 late deaths (stroke, colon cancer).
• Complete thrombosis of the false lumen was observed in all patients post-stent graft placement, with two patients requiring secondary interventions.

Conclusions:

• The frozen elephant trunk technique demonstrates acceptable outcomes for retrograde type A aortic dissection, despite significant preoperative morbidity.
• This technique may offer a favorable prognosis for patients with this challenging aortic pathology.