Efficacy of Total Aortic Arch Replacement Combined with Frozen Elephant Trunk in Aortic Reoperation

Abstract

Background The aim of this study was to estimate the long-term efficacy of total aortic arch replacement combined with the frozen elephant trunk (TAR+FET) technique for aortic disease following a prior cardiac surgery procedure. Material/Methods We performed TAR+FET for 118 patients for major vessel disease following a prior cardiac procedure with median sternotomy incision. All patients were divided into 5 groups: in group A, the prior major procedure was aortic valve replacement (AVR); in group B, the prior major procedure was isolated ascending aorta replacement; in group C, the prior major procedure was aortic root replacement; in group D, the prior major procedure was aortic arch replacement or intervention; and in group E, the prior major procedure was ‘other’ cardiac operative procedure. The long-term follow-up visit results were estimated using the Kaplan-Meier method. Results The 30-day mortality rate after the operation was 13.6% (16/118) – 2 died in group A, 1 in group B, 8 in group C, 4 in group D, and 1 in group E. Follow-up visits were completed in 99% of patients. The mean follow-up time was 47.6±36.3 months and 12 patients had died by follow-up, so the total long-term survival rate was 76.3%. One-year survival rates of the 5 groups were 85% (group A), 93.8% (group B), 82.3% (group C), 50% (group D), and 50% (group E), respectively. Five-year survival rates of the 5 groups were 85%, 93.8%, 80.6%, 50%, and 50%, respectively. Conclusions The TAR+FET technique is feasible and efficacious for aortic reoperation in patients who previously underwent cardiac surgery since the short-term mortality in patients with recurrent aortic arch disease after cardiac surgery is not high.

An Analysis of Total Arch Re-Replacement After Proximal Aortic Surgery

“…Etiology of reoperation after aortic surgery: (1) The new aortic dissection involved the arch; (2) The aortic arch was severely expanded to a diameter of more than 5 cm; (3) Severe inner leakage or anastomotic leakage occurred at the proximal end of the descending aortic stent after the arch surgery; and (4) The artificial blood vessel of the previous arch surgery was infected [Sun 2019]. In our statistics, it was found that dissection was the main cause of secondary TAR because more than half of TEVAR surgeries were performed, and the rupture was more likely to occur in the proximal attachment area of the stent.…”

“…We analyzed TAR surgery, which was a more complicated operation with difficult prognosis to control in the secondary mode. After reviewing the literature, we found that 30-day mortality was 13.6% under this condition [Sun 2019]. The 3-and 5-year survival rates of TAR with primary quadriforcated vascular prosthesis were 87% and 81%, respectively [Minatoya 2019].…”