Repeat Surgery in Chronic Aortic Dissection: A New Technique without Touching the Native Aorta

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Surgery
• Aortic Dissection Repair

Background:

• Repeat surgery for chronic aortic dissection after Type-A acute aortic dissection (AAD) repair is challenging.
• Existing techniques like staged procedures, traditional frozen elephant trunk (FET), and thoracic endovascular aortic repair (TEVAR) have limitations.
• Enlargement of the aorta and limited graft length in prior repairs complicate reoperative access and landing zone creation.

Purpose of the Study:

• To evaluate a modified FET technique for reoperative repair of chronic aortic dissection.
• To assess the safety and efficacy of this modified approach in patients with prior ascending aorta replacement.

Main Methods:

• Retrospective review of five consecutive patients treated between 2014-2017.
• Utilized a modified FET technique involving total aortic arch and descending aorta exclusion without manipulating the native dissected aorta.
• Anastomosed the stent graft to the existing ascending aorta graft at Hishimaru's zone 0, rerouting cerebral vessels.

Main Results:

• No early or midterm mortality observed.
• Mean follow-up of 22 months with no major or minor neurologic events.
• Mean interval between surgeries was 26 months; mean circulatory arrest time was 16 minutes.

Conclusions:

• The modified FET technique is a viable and safe option for complex reoperative aortic dissection.
• This approach successfully excluded the dissected aorta without direct manipulation, achieving good short-term outcomes.
• Further studies with larger patient numbers and longer follow-up are needed to validate these findings.