Total aortic arch replacement using elephant trunk or frozen elephant trunk technique: a case-control matching study

Abstract

Background: Surgical management of aortic arch diseases is one of the most challenging issues in cardiovascular surgery. The aim of this study was to compare the outcome after frozen elephant trunk (FET) with conventional elephant trunk (ET) technique. Methods: Out of a total of 551 patients after thoracic aortic surgery, we analyzed 70 consecutive patients, who underwent aortic arch replacement with ET or FET technique between 2001 and 2017 in our institution. The patients were case-control matched in regard to such variables as age, sex, presence of an acute aortic dissection and necessity for concomitant procedures. The analysis included 25 patient pairs. Results: Among the 25 FET patients, eleven patients were female, the median age was 69, 15 (60%) patients had an aortic dissection and thirteen needed various concomitant procedures. In the second group, treated with conventional ET technique, 10 (40%) patients were female, the median age was 66 years, thirteen presented with an aortic dissection and 16 (64%) underwent concomitant procedures. These and other characteristics did not differ significantly between the groups. In-hospital mortality was statistically similar: 5 (20%) in the FET group vs. 8 (32%) for ET group (P=0.52). The incidence of stroke, acute renal failure and postoperative bleeding was comparable. The length of stay in the intensive care unit did not differ between the cohorts (P=0.258). Predictors of in-hospital mortality were length of the operation, bleeding postoperatively, and acute renal failure. The one-year survival rates were higher in the FET cohort compared to the conventional approach (60% vs. 38%), however without statistical significance. Conclusion: In regard to the short-and mid-term outcome, there were only slight differences between both techniques. In patients with extensive aneurysmal aortic disease, conventional ET and FET procedures seem to be associated with acceptable satisfactory mid-term outcome.

Preoperative hypoxemia in patients with type A acute aortic dissection: a retrospective study on incidence, related factors and clinical significance

“…Affected patients experience acute onset and rapid progression necessitating emergency surgical treatment (1). The in hospital mortality rate in aortic dissection patients is 34% in a recent study (2). AAD is often accompanied by several severe systemic pathophysiological changes, of which hypoxemia (HO) is the most common.…”

The great vessel freeze‐out: A meta‐analysis of conventional versus frozen elephant trunks in aortic arch surgery

“…In‐hospital mortality, as well as the incidence of stroke and acute renal failure were comparable between the groups, although the authors did not report use of a CSF drain. While the 1‐year survival rates were higher in the FET cohort compared to the CET approach (60% vs. 38%), these results were reported without statistical significance 20 …”

Correlation of coagulopathy and frozen elephant trunk use in aortic arch surgery: A systematic review and meta‐analysis

“…After application of inclusion and exclusion criteria, a total of 46 studies 5–48 consisting of 6313 patients included in this meta‐analysis (Figure 1). The patients’ mean age was 57.5 (95% CI: 55.1–55.9).…”