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. 2021 Jun 28;33(1):85-92.
doi: 10.1093/icvts/ivab059.

Outcome of the frozen elephant trunk procedure as a redo operation

Till Joscha Demal  1 , Lennart Bax  1 , Jens Brickwedel  1 , Tilo Kölbel  2 , Eik Vettorazzi  3 , Franziska Sitzmann  1 , Hermann Reichenspurner  1 , Christian Detter  1
Affiliations

Outcome of the frozen elephant trunk procedure as a redo operation

Till Joscha Demal et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: The goal of this study was to determine the outcome of patients undergoing an elective frozen elephant trunk (FET) procedure as a redo operation following previous cardiac surgery.

Methods: One hundred and eighteen consecutive patients underwent FET procedures between October 2010 and October 2019 at our centre. Patients were registered in a dedicated database and analysed retrospectively. Clinical and follow-up characteristics were compared between patients undergoing a FET operation as a primary (primary group) or a redo procedure (redo group) using logistic regression and Cox regression analysis. Emergency procedures (n = 33) were excluded from the analysis.

Results: A total of 36.5% (n = 31) of the FET procedures were redo operations (redo group) and 63.5% (n = 54) of the patients underwent primary surgery (primary group). There was no significant difference in the 30-day mortality [primary group: 7.4%; redo group: 3.2%; 95% confidence interval (CI) (0.19-35.29); P = 0.63] and the 3-year mortality [primary group: 22.2%; redo group: 16.7%; 95% CI (0.23-3.23); P = 0.72] between redo and primary cases. Furthermore, the adjusted statistical analysis did not reveal significant differences between the groups in the occurrence of transient or permanent neurological deficit, paraplegia, acute renal failure and resternotomy. The redo group showed a higher rate of recurrent nerve palsy, which did not reach statistical significance [primary group: 3.7% (n = 2); redo group: 19.4% (n = 6); P = 0.091].

Conclusions: Elective FET procedures as redo operations performed by a dedicated aortic team following previous cardiac surgery demonstrate an adequate safety profile.

Keywords: Aortic aneurysm; Aortic arch replacement; Endovascular procedures; Frozen elephant trunk; Reoperation.

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Figures

Figure 1:
Figure 1:
Inclusion and exclusion of patients. Emergency patients were excluded from the analysis. FET: frozen elephant trunk.
Figure 2:
Figure 2:
Computed tomography (CT) scans of a 57-year-old female patient with residual dissection after type A dissection and thoracic false lumen aneurysm measuring 6.0 cm in diameter. The patient had a biological Bentall procedure in combination with a biological mitral valve replacement 28 years earlier and mechanical mitral and aortic valve replacements 16 years earlier. The persistent false lumen aneurysm was treated by performing a frozen elephant trunk (FET) procedure. (A) CT scan prior to the FET procedure. (B) 3-Dimensional reconstruction of the preoperative CT scan. (C) CT scan after the FET procedure.
Figure 3:
Figure 3:
Kaplan–Meier estimates of survival by group (primary vs redo frozen elephant trunk procedure). The CIs are presented in the background in black and rose, respectively. The estimation does not reveal a significant difference in the survival between the groups during a 3-year follow-up period (P = 0.75). CI: confidence interval; HR: hazard ratio.
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