Multicentre frozen elephant trunk technique experience as redo surgery to treat residual type A aortic dissections following ascending aortic replacement

Abstract

Objectives: The goal of this project was to assess the efficacy of a reoperative frozen elephant trunk (FET) operation for treating residual type A aortic dissections.

Methods: Between April 2015 and October 2023, a total of 237 patients underwent elective redo surgical aortic arch replacement via the FET technique to treat residual type A aortic dissection in 11 European aortic centres. Data were pooled and analysed retrospectively.

Results: The time between an acute type A dissection repair to an FET implant was 5 years. More than half of all patients (54%) presented with an entry within the aortic arch, and 174 patients (73%) presented residual dissections of supra-aortic vessels. During FET repair, the axillary artery was cannulated in 181 patients (76%), whereas 83 patients (35%) underwent additional cardiac procedures including 39 root replacements (16%) and 15 coronary bypass procedures (6%). Zone 2 was the most common arch anastomosis site (n = 163, 69%), and bilateral antegrade cerebral perfusion was most frequent (n = 159, 67%). Fifteen patients (6%) died in-hospital. Age in years (P < 0.001, odds ratio: 1.069) proved to be predictive for overall mortality in our Cox regression model.

Conclusions: Elective redo surgical aortic arch replacement using the FET technique for treating residual type A aortic dissection following ascending aortic replacement revealed a favourable outcome. The decision to undertake stage two therapy of a residually dissected aortic arch should be made by an aortic team on a patient-by-patient basis.

Keywords: Aortic arch; Frozen elephant trunk; Redo surgery; Type A dissection.