Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Management

Background:

• Acute Type A aortic dissection (AAAD) presents a significant surgical challenge, particularly with extensive arch and descending aorta involvement (DeBakey Type I).
• Frozen elephant trunk (FET) technology offers a potential solution for improved false lumen thrombosis and long-term outcomes in these complex cases.
• This study evaluates the feasibility and outcomes of FET in AAAD within a low-volume surgical center.

Purpose of the Study:

• To assess the feasibility and outcomes of total aortic arch replacement with FET in patients with AAAD.
• To determine if a low-volume center can achieve acceptable results with this technically demanding procedure.
• To evaluate the safety and efficacy of FET in managing DeBakey Type I AAAD.

Main Methods:

• A retrospective analysis of 12 patients with AAAD who underwent FET procedures between January 2011 and December 2016.
• Patients had intimal tears in the aortic arch and/or proximal descending aorta.
• Concomitant procedures included aortic valve replacement, Bentall procedure, and aortic valve repair.

Main Results:

• Operative mortality was 16.7% (2/12 patients).
• Stroke and re-thoracotomy for bleeding occurred in 8% of patients each (1/12).
• No spinal cord injuries were observed, and no deaths or reoperations on the downstream aorta occurred during a mean follow-up of 36.1 months.

Conclusions:

• FET repair for AAAD is feasible and yields acceptable results, even in a low-volume center.
• The technique requires high technical proficiency but represents a promising option for managing complex AAAD.
• Long-term follow-up demonstrated no late reoperations or deaths related to the downstream aorta.