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Multicenter Study
. 2020 Apr;159(4):1189-1196.e1.
doi: 10.1016/j.jtcvs.2019.03.097. Epub 2019 Apr 14.

Frozen elephant trunk does not increase incidence of paraplegia in patients with acute type A aortic dissection

Shi Sum Poon  1 , David H Tian  2 , Tristan Yan  3 , Deborah Harrington  1 , Omar Nawaytou  1 , Manoj Kuduvalli  1 , Axel Haverich  4 , Marek Ehrlich  5 , Wei-Guo Ma  6 , Li-Zhong Sun  6 , Anthony L Estrera  7 , Mark Field  8 ; International Aortic Arch Surgery Study Group
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Free article
Multicenter Study

Frozen elephant trunk does not increase incidence of paraplegia in patients with acute type A aortic dissection

Shi Sum Poon et al. J Thorac Cardiovasc Surg. 2020 Apr.
Free article

Abstract

Objective: We seek to assess the safety of total arch replacement with frozen elephant trunk for acute type A aortic dissection in respect to the risks of operative mortality, stroke, and paraplegia using an international multicenter registry (ARCH).

Methods: The ARCH Registry database from 37 participating centers was analyzed between 2000 and 2015. Patients who underwent emergency surgery for acute type A aortic dissection treated by total arch replacement with or without frozen elephant trunk were included. Operative mortality, permanent neurologic deficits, and spinal cord injury were primary end points. These end points were analyzed using univariate and hierarchical multivariate regression analyses, as well as conditional logistic regression analysis and post hoc propensity-score stratification.

Results: A total of 11,928 patients were enrolled in the ARCH database, of which 6180 were managed with total arch replacement. A comprehensive analysis was performed for 978 patients who underwent total aortic arch replacement for acute type A aortic dissection with or without frozen elephant trunk placement. In propensity-score matching, there were no significant differences between total arch replacement and frozen elephant trunk in terms of permanent neurologic deficits (11.9% vs 10.1%, P = .59) and spinal cord injury (4.0% vs 6.3%, P = .52) For patients included in the post hoc propensity-score stratification, frozen elephant trunk was associated with a statistically significantly lower mortality risk (odds ratio, 0.47; P = .03).

Conclusions: The use of frozen elephant trunk for acute type A aortic dissection does not appear to increase the risk of paraplegia in appropriately selected patients at experienced centers. The exact risk factors for paraplegia remain to be determined.

Keywords: aortic aneurysm; aortic arch; paraplegia; total arch replacement; type A aortic dissection; vascular prostheses/frozen elephant trunk.

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