The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience†

Abstract

We aimed to evaluate the long-term prognosis of prophylactic repair of the descending aorta using the frozen elephant trunk (FET) technique for acute type A aortic dissection (AAAD). Between 1997 and 2012, 120 consecutive patients (mean age: 64.4 ± 10.9 years) underwent total arch replacement with FET for AAAD; 36 patients had an entry at the descending aorta, 68 patients were aged <70 years and 8 patients had Marfan's syndrome. With regard to preoperative morbidity, 23 patients had stroke, 10 had coronary ischaemia and 9 had visceral ischaemia. During intraoperative measurement, the required size and length of the stent graft were determined and inserted under transoesophageal echographic guidance. Seven patients (6%) died in the hospital. Four (3%) cases of stroke and 2 (2%) with spinal cord injuries were noted. Computed tomography prior to discharge indicated complete thrombosis of the false lumen by the stent graft in 113 patients, with a mean diameter of 26.0 ± 2.5 mm before discharge and 27.5 ± 2.5 mm at 1 year postoperatively compared with a mean stent graft diameter of 27.8 ± 1.7 mm. During the long-term follow-up (mean period: 104.6 ± 51.9 months), 12 patients died of non-aortic events and 5 distal aortic reoperations were required using endovascular stent grafting of the descending aorta, including 1 case with new tear formation. None of the patients had a patent false lumen on the stent graft at the final follow-up. The 10-year survival rate was 75% and the overall 10-year reoperation-free rate on the thoracic aorta was 93%. The FET technique results in excellent aortic remodelling of the downstream aorta and can improve the long-term outcomes for AAAD.