One-year outcomes of total arch replacement and frozen elephant trunk using the E-vita Open NEO

Abstract

OBJECTIVES In this cohort study, we aimed to assess the 1-year clinical outcomes of using the E-vita Open NEO™ hybrid prosthesis for total arch replacement with frozen elephant trunk to repair extensive aortic pathologies. METHODS A total of individuals who underwent thoracic aortic surgery between April 2021 and March 2023 were identified from the review of the Gangnam Severance Aortic Registry. Exclusion criteria included ascending aortic replacement, 1 or 2 partial arch replacement, descending aortic replacement, and total arch replacement without a frozen elephant trunk. Finally, All consecutive patients who underwent total arch replacement and frozen elephant trunk with E-vita Open NEO™ for aortic arch pathologies between April 2021 and March 2023 were included in this cohort study. The patients were divided into three groups based on their pathology: acute aortic dissection, chronic aortic dissection, and thoracic aortic aneurysm. The primary end-point was in-hospital mortality. The secondary end-points during the postoperative period comprised stroke, spinal cord injury, and redo sternotomy for bleeding. Additionally, the secondary end-points during the follow-up period included the 1-year survival rate, 1-year freedom from all aortic procedures, and 1-year freedom from unplanned aortic interventions. RESULTS The study included 167 patients in total: 92 patients (55.1%) with acute aortic dissection, 20 patients (12.0%) with chronic aortic dissection, and 55 patients (32.9%) with thoracic aortic aneurysm. The in-hospital mortality was 1.8% (n = 3). Stokes occurred in 1.8% (n = 3) of the patients, spinal cord injury in 1.8% (n = 3), and redo sternotomy for bleeding was performed in 3.0% (n = 5). There were no significant differences between the pathological groups. The median follow-up period (quartile1-quartile3) was 198 (37–373) days, with 1-year survival rates of 95.9%. The freedom from all aortic procedures and unplanned aortic interventions were 90.3% and 92.0% at 1 year, respectively. CONCLUSIONS The 1-year clinical outcomes of total arch replacement with frozen elephant trunk using the E-vita Open NEO™ were favourable. Long-term follow-up is required to evaluate the durability of the frozen elephant trunk.