Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

Abstract

Aim: To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Methods and results: Between January 2001 and December 2012, 34 patients (mean age 59.9 AE 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 AE 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid-and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. Conclusions: In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up.

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

“…As reported by Shrestha et al (17), the 100% rate of FL thrombosis achieved using Thoraflex TM shows its superiority to other devices as seen by the 82.1% and 89.4% rates reported by Kobayashi et al (16) and Chen et al (18), respectively. Yet it is important to take into consideration the differences amongst these 3 independent studies.…”

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.…”

Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiothoracic Surgeons

“…There is an increasing tendency for more aggressive surgery including antegrade stent deployment in the descending thoracic aorta at the time of open aortic arch repair [54][55][56][57]. Distal false lumen obliteration is achieved in the vast majority of cases [56][57][58]. However, this approach has not yet been proven to be the procedure of choice, is certainly more complex, poses higher risk for patients and should be performed in high volumes centres [59][60][61][62][63].…”