Total aortic arch replacement with the frozen elephant trunk procedure in acute DeBakey type I aortic dissections

In patients with acute aortic dissection involving the arch and the descending aorta (AADA DeBakey type I), performing a total aortic arch replacement with the frozen elephant trunk (FET) procedure for supposedly better long-term results is still controversial.

From February 2004 to April 2016, 94 patients with AADA DeBakey type I had an FET procedure (80% men, age 58 ± 12 years). During the early period (Group 1, 2004-10), the FET technique was performed using non-branched grafts. Thirty-two percent (9/28) underwent concomitant aortic valve-sparing root procedures. More recently (Group 2, 2010-16), branched FET grafts were used in 66 patients (76% men, age: 56 ± 12 years). Fifty-six percent (37/66) underwent concomitant aortic valve-sparing root procedures.

Patients showed a high rate of malperfusion syndrome (Group 1: 29% vs Group 2: 38%, P = 0.48). In-hospital mortality was 12% (Group 1: 21% vs Group 2: 9%, P = 0.17). Stroke and rethoracotomy for bleeding occurred in 15% (Group 1: 11% vs Group 2: 17%) and 20% (Group 1: 21% vs Group 2: 20%; P = 1.00) of patients, respectively. Postoperative recurrent nerve palsy and spinal cord injury rates were 18% (Group 1: 14% vs Group 2: 20%) and 5% (Group 1: 7% vs Group 2: 5%; P = 0.63). During follow-up, 11 patients (12%) required reoperation on the downstream aorta (open surgical: n = 6/94, 6%, endovascular: n = 5/94; 5%). Survival tended to be superior in Group 2 (5 years: Group 1: 68% vs Group 2: 80%; P = 0.17).

The FET procedure improves short- and long-term outcome, especially for AADA DeBakey I with malperfusion.