Journal
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Volume 59, Issue 1, Pages 130-136Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ejcts/ezaa288
Keywords
Aortic dissection; Frozen elephant trunk; Redo arch surgery; Arch replacement
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The study evaluated the outcomes of aortic arch replacement using the frozen elephant trunk technique in patients who had previous proximal and/or distal open or endovascular thoracic aortic repair. The results showed low mortality and morbidity rates, but postoperative stroke remained a concern. After successful procedures, the approach provided an ideal platform for subsequent surgical or endovascular downstream aortic interventions that are often necessary.
OBJECTIVES: The goal of this study was to evaluate outcomes of aortic arch replacement using the frozen elephant trunk (FET) technique after previous proximal and/or distal open or endovascular thoracic aortic repair. METHODS: Sixty-three patients [median age: 63 (55-74) years; 65% men] were operated on for acute or chronic aortic dissection after previous proximal and/or distal open or endovascular thoracic aortic repair. Intraoperative details, clinical outcome and follow-up results were evaluated. RESULTS: The median time between the index and the FET procedure was 81 (40-113) months. Fifty-eight (92%) patients had already undergone proximal aortic surgery; supracoronary ascending aortic replacement was the most frequent index procedure [n=25 (40%)]. Distal aortic interventions had been done in 8 (13%) patients including endovascular thoracic aortic repair in 6 patients (10%). In-hospital mortality was 3% (n=2). Postoperative strokes occurred in 5 patients (8%); of those, 1 stroke was dissection-related (2%). Subsequent aortic reinterventions after the FET procedure had to be done in 33% (n=21). CONCLUSIONS: Outcomes of aortic arch replacement using the FET technique after previous proximal and/or distal open or endovascular thoracic aortic repair are associated with low mortality and morbidity. Still, postoperative stroke remains an issue. After the successful accomplishments, the approach serves as an ideal platform for the secondary surgical or endovascular downstream aortic procedures, which are frequently needed.
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