Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection

• Published in: Interactive cardiovascular and thoracic surgery 2019-11, Vol.29 (5), p.753-760
• Main Authors: Furutachi, Akira, Takamatsu, Masanori, Nogami, Eijiro, Hamada, Kohei, Yunoki, Junji, Itoh, Manabu, Kamohara, Keiji
• Format: Article
• Language: English
• Subjects: Acute Disease; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - surgery; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis Implantation - methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prosthesis Design; Stents - adverse effects; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1569-9285; 1569-9285
• DOI: 10.1093/icvts/ivz154

Abstract OBJECTIVES The aim of this study was to evaluate the outcomes of the frozen elephant trunk (FET) technique, using the J Graft FROZENIX for Stanford type A acute aortic dissection, in comparison with the unfrozen elephant trunk technique. METHODS Between January 2010 and August 2018, we performed total arch replacement for Stanford type A acute aortic dissection in our hospital. Thirty patients were treated by the elephant trunk procedure (ET group), and 20 patients were treated by the FET procedure (FET group). To evaluate aortic remodelling, we measured the area of the aorta, the true lumen and the false lumen at 12 months of follow-up. RESULTS Preoperative characteristics and operation time were not significantly different between the 2 groups. The quantity of blood transfused was much greater in the ET group than in the FET group. Resection or closure of the most proximal entry tear was obtained in 73.3% (22 out of 30 patients) in the ET group and 100% (20 out of 20 patients) in the FET group (P = 0.015). There was no case that had recurrent nerve palsy or paraplegia in the FET group. Stent graft-induced new entry occurred in 3 cases (15.8%) in the FET group. There were no significant differences between the 2 groups in aortic area, true lumen area or false lumen area. CONCLUSIONS Total arch replacement with the FET technique in Stanford type A acute aortic dissection carries a risk of distinct complications; however, with thorough advance planning, it should be possible to safely institute this treatment. Further randomization, with a comparison of each technique, is required to provide clear conclusions whether the FET is useful for acute Stanford type A aortic dissection.