The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: a multicenter experience

Abstract

Background: Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique.

Methods: Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry. Ninety of the patients, who were the population in the present study, underwent operations for chronic dissection of the aorta (type A, 77%). The mean age of these 90 patients was 57 ± 12 years, and 72 (80%) of the patients were male. Sixty-two patients (69%) had undergone a previous aortic operation. All of the procedures in the study were performed with the aid of antegrade selective cerebral perfusion.

Results: Total replacement of the aortic arch was done in 84 patients (93%). Cardiopulmonary bypass, myocardial ischemia, cerebral perfusion, and visceral ischemia times were 243 ± 65, 145 ± 48, 86 ± 24, and 75 ± 22 minutes, respectively. In-hospital mortality was 12% (11 patients). One patient died from a stroke and 8 patients (9%) died from ischemic spinal cord injury. The false lumen (FL) in the patients' aortae was evaluated with computed tomography after operation and during follow up. The rates of complete thrombosis of the FL around the elephant trunk were 69% and 79% at the first and last postoperative examinations, respectively. The rates of 4-year survival and freedom from aortic reoperation were 78% ± 5% and 96% ± 3%, respectively.

Conclusions: The treatment of chronic aortic dissection (AD) with the FET technique is feasible, with respectable results. The rate of aortic reoperation with the use of this technique appears to be lower than that with a conventional approach to the repair of chronic AD. Ischemic spinal cord injury represents a concerning complication of the FET technique but seems to be unrelated to thrombosis of the FL.