Aortic arch replacement with frozen elephant trunk technique - a single-center study.

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Disease
• Minimally Invasive Techniques

Background:

• The frozen elephant trunk (FET) technique was developed for complex thoracic aorta pathologies.
• It is routinely used for both acute and chronic aortic syndromes.
• FET facilitates two-stage surgical repair of extensive aortic diseases.

Purpose of the Study:

• To evaluate the safety and efficacy of the FET technique in patients with acute and chronic aortic syndromes.
• To compare outcomes between acute aortic syndromes and chronic degenerative aortic disease.
• To assess the impact of FET on true lumen expansion and need for re-intervention in acute aortic dissection.

Main Methods:

• A retrospective analysis of 68 patients who underwent aortic arch repair using the FET technique between 11/2006 and 07/2017.
• Patients were divided into two groups: Group 1 (acute aortic dissection/ulcer) and Group 2 (aortic aneurysm/chronic dissection), with 34 patients each.
• Two types of hybrid prostheses were used: Jotec E-vita Open (n=57) and Vascutek Thoraflex (n=11).

Main Results:

• Early mortality was 13.2% (14.7% in group 1 vs. 11.7% in group 2).
• Neurological complications occurred in 17.6% of patients (stroke 8.8%, spinal cord injury 8.8%).
• 1-, 3-, and 7-year survival rates were 80.9%, 80.9%, and 74.2%, respectively, with no significant difference between groups. True lumen expansion was significant in dissection patients, and 1-, 3-, 7-year freedom from re-intervention was 96.9%, 90.2%, and 82.7%.

Conclusions:

• The FET technique is applicable to acute aortic syndromes with risks comparable to chronic degenerative aortic disease.
• FET implantation leads to favorable midterm outcomes and prolonged freedom from secondary interventions in acute aortic dissection.
• Postoperative true lumen expansion and false lumen reduction are associated with positive clinical results.