Early and mid-term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aortic dissection

Abstract

Objective This study aimed to evaluate the prevalence of spinal cord injury in total arch replacement with frozen elephant trunk for acute type A aortic dissection using our spinal cord protection technique. Methods Between January 2013 and December 2017, 33 patients underwent total arch replacement with frozen elephant trunk for acute type A aortic dissection (mean age 67.9 ± 13.3 years). Our spinal cord protection technique involved maintaining extracorporeal circulation through the left subclavian artery in all procedures, using aortic occlusion balloon during distal anastomosis, and inserting frozen elephant trunk above Th 8 with transesophageal echocardiographic guidance. Computed tomography was performed within 1–2 weeks, 12 months, and 36 months postoperatively. We compared the degree of thrombosis of the descending aorta between preoperation and early postoperative period by Fisher’s exact test. Moreover, we evaluated postoperative mortality and mobility (including spinal cord injury) at follow-up. Results The operative mortality within 30 days was 6.1%. Neither paraplegia nor paraparesis was noted. We observed significant thrombosis of the false lumen at the distal arch and aortic valve level of the descending aorta in postoperative early term period (p < 0.01). At mid-term follow-up (mean 33.9 months), survival probability and 3-year freedom from reoperation rates were 93.9 ± 4.1% and 95.0 ± 4.9%, respectively. Conclusions The frozen elephant trunk technique with our spinal protection strategy provides good postoperative outcomes. Our strategy can maintain spinal cord perfusion without complete ischemia time even during lower body ischemia time. Implementation of our spinal protection strategy will help prevent spinal cord injury and dilated downstream aorta.

Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis

“…After reviewing shreds of evidence, a total of 35 studies including 3211 patients were entered into the quantitative analysis (Figure 1). 11–44 The median size of reviewed reports was 72 patients (interquartile range 38 – 122). The majority of studies were performed in Chinese institutions, 19 studies including 2026 patients.…”

Aortic remodeling, distal stent‐graft induced new entry and endoleak following frozen elephant trunk: A systematic review and meta‐analysis

“…A total of 79,931 records were collected via online database review, out of which 7345 studies were eligible for abstract screening. After applying the exclusion criteria, 109 records were adopted for full‐text screening, and eventually, reported data of 43 studies including 5068 patients who underwent TAR with FET were reviewed 4,15–56 (Figure 1).…”

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

“…Besides mortality, neurological complications are often the most devastating and the most feared, as permanent stroke and spinal cord injury can have a significant impact on survival and quality of life even in the mid-term. The left subclavian artery is supposed to play a major neuroprotective role in collateral perfusion as it connects to the vertebral artery as well as the internal thoracic artery, allowing intercostal arteries to deliver blood supply to the spinal arterial collateral network as described by Griepp et al 17 18 19…”