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Multicenter Study
. 2020 Apr;159(4):1201-1211.
doi: 10.1016/j.jtcvs.2019.03.121. Epub 2019 May 11.

Total aortic arch replacement with frozen elephant trunk technique: Results from two European institutes

Alessandro Leone  1 , Erik Beckmann  2 , Andreas Martens  2 , Luca Di Marco  3 , Antonio Pantaleo  3 , Letizia Bacchi Reggiani  4 , Axel Haverich  2 , Roberto Di Bartolomeo  3 , Davide Pacini  3 , Malakh Shrestha  2
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Free article
Multicenter Study

Total aortic arch replacement with frozen elephant trunk technique: Results from two European institutes

Alessandro Leone et al. J Thorac Cardiovasc Surg. 2020 Apr.
Free article

Erratum in

  • Notice of Correction.
    [No authors listed] [No authors listed] J Thorac Cardiovasc Surg. 2020 Jun;159(6):2571. doi: 10.1016/j.jtcvs.2020.03.060. J Thorac Cardiovasc Surg. 2020. PMID: 32422854 No abstract available.

Abstract

Objective: We report on a large series of patients treated at the S. Orsola Hospital, University of Bologna (Bologna, Italy) and Hannover Medical School (Hannover, Germany), with the aim to evaluate the early and midterm results.

Methods: Between January 2007 and March 2017, 437 patients underwent total aortic arch replacement with the frozen elephant trunk technique. The frozen elephant trunk prostheses used were the custom-made Chavan-Haverich (Hanover, Germany) (n = 27, 6%), Jotec E-vita open (Jotec Inc, Hechingen, Germany) (n = 192, 44%), and Vascutek Thoraflex-Hybrid (Vascutek, Inchinnan, Scotland) (n = 218, 50%). The main indications were thoracic aortic aneurysm (n = 135, 31%), chronic aortic dissection (n = 182, 41.6%), and acute aortic dissection (n = 120, 27.5%).

Results: Overall in-hospital mortality was 14.9%, and permanent neurologic deficit and spinal cord injury were 10.8% and 5.5%, respectively. Patients with chronic aortic dissection presented a better in-hospital mortality rate than the thoracic aortic aneurysm and acute aortic dissection groups. Independent risk factors for mortality in the overall population were prolonged cardiopulmonary bypass time, age, urgent/emergency surgery, and Marfan syndrome. The median (p25, p75) follow-up time was 2.6 (1.4-4.4) years, and the mortality rate was 7.01 (95% confidence interval, 5.7-8.7) per 100 patient-years. A total of 86 patients (23.1%) required an additional procedure during the follow-up; 61 (16.3%) required endovascular extensions, and 25 (6.7%) required aortic surgery.

Conclusions: The frozen elephant trunk technique is a treatment option for all complex pathologies of the thoracic aorta. Patients with thoracic aortic aneurysms presented a higher mortality rate, and in patients with acute aortic dissection, the malperfusion syndrome still remains a catastrophic complication. The midterm follow-up showed satisfactory results in terms of survival and freedom from reintervention.

Keywords: aortic arch; aortic dissection; frozen elephant trunk.

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Comment in

  • Commentary: Despite global warming, frozen has its place.
    Coselli JS. Coselli JS. J Thorac Cardiovasc Surg. 2020 Apr;159(4):1212-1213. doi: 10.1016/j.jtcvs.2019.04.049. Epub 2019 Apr 30. J Thorac Cardiovasc Surg. 2020. PMID: 31160114 No abstract available.
  • Discussion.
    [No authors listed] [No authors listed] J Thorac Cardiovasc Surg. 2020 Apr;159(4):1209-1211. doi: 10.1016/j.jtcvs.2019.03.127. Epub 2019 Jun 14. J Thorac Cardiovasc Surg. 2020. PMID: 31208805 No abstract available.

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