Left Subclavian Artery Sacrifice in Acute Aortic Dissection Repair using the Frozen Elephant Trunk

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Acute aortic dissection requires complex surgical repair, often involving the frozen elephant trunk (FET) technique.
• The left subclavian artery (LSA) origin can be involved in dissection, necessitating sacrifice during FET repair.
• The LSA's role in neuroprotection as a collateral pathway raises concerns about its sacrifice.

Purpose of the Study:

• To evaluate the neurological outcomes associated with LSA sacrifice during FET repair for acute aortic dissection.
• To determine if LSA sacrifice increases the risk of stroke or spinal cord injury in these patients.

Main Methods:

• Retrospective analysis of 84 patients undergoing FET repair for acute aortic dissection (October 2009 - April 2018).
• Comparison of neurological outcomes between patients who underwent LSA sacrifice (n=19) and those who did not.
• Assessment of postoperative stroke, spinal cord injury, and transient neurological deficits.

Main Results:

• No instances of new postoperative stroke or spinal cord injury were observed in the LSA sacrifice group.
• No temporary neurological deficits occurred in patients whose LSA was sacrificed.
• In-hospital mortality was similar between groups (15.5% overall), with no significant difference related to LSA sacrifice.

Conclusions:

• LSA sacrifice is a safe and viable option in selected cases of acute aortic dissection undergoing FET repair when the LSA origin cannot be preserved.
• Sacrificing the LSA does not appear to elevate the risk of central or spinal neurological injury.
• Carotid-subclavian artery bypass is infrequently required as a secondary procedure for arm symptoms after LSA sacrifice.