What is the clinical evidence from this study?

Study design: Cohort. Population: Extensive aortic disease (aortic aneurysm, acute or chronic aortic dissection) (n=132). Intervention: Complete aortic arch replacement employing the frozen elephant trunk (FET) technique. Primary outcome: 30-day mortality.

What does this research mean for the field?

Complete aortic arch replacement using the frozen elephant trunk technique is a safe and effective treatment for extensive aortic disease, resulting in a 30-day mortality rate of 7.6% and a 3-year overall survival of 87%. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

November 5, 2024Open Access

Contemporary Single-Center Experience of Complete Aortic Arch Replacement Employing the Frozen Elephant Trunk Technique in Patients with Extensive Aortic Disease

ASArmin-Kai SchoeberlMedical University of Vienna FHFlorian HuberParacelsus Medical University BSBruno SchachnerJohannes Kepler University of Linz

Key Result

Complete aortic arch replacement using the frozen elephant trunk technique resulted in a 30-day mortality rate of 7.6% and a 3-year overall survival of 87%.

Study Design

Type

Cohort (n=132)

Multicenter

Structured PICO

What are the contemporary clinical outcomes and survival rates following total aortic arch replacement using the frozen elephant trunk technique in patients with extensive aortic disease?

Population

132 consecutive patients with extensive aortic disease, including aortic aneurysm (n = 32), acute aortic dissection (n = 32), or chronic aortic dissection (n = 68)

Intervention

Total aortic arch replacement employing the frozen elephant trunk (FET) technique

Outcome

30-day mortality, postoperative complications, reintervention rates, and overall survivalhard clinical

The frozen elephant trunk technique for total aortic arch replacement demonstrates acceptable 30-day mortality (7.6%) and good mid-term survival (87% at 3 years) in a contemporary all-comers cohort with extensive aortic disease.

Abstract

Objective: This study aimed to examine contemporary results of the frozen elephant trunk (FET) procedure in an all-comers patient cohort. Methods: Between January 2017 and May 2024, a total of 132 consecutive patients with either aortic aneurysm (n = 32), acute aortic dissection (n = 32), or chronic aortic dissection (n = 68) underwent total aortic arch replacement employing the FET technique. In-hospital data were collected prospectively and included preoperative characteristics, intraoperative data, and follow-up results. Results: The median cardiopulmonary bypass time, cardiac ischemia time, and selective antegrade cerebral perfusion time were 180 (161–205), 89 (70–113), and 45 (38–54) min, respectively. Total 30-day mortality rate was 7.6% (n = 10). The rate of major postoperative neurological complications was 6.8% (n = 9) for perioperative stroke and 2.3% (n = 3) for permanent spinal cord injury. Five patients (3.8%) required hemofiltration at the time of discharge due to postoperative kidney injury. Rates of subsequent endovascular and open aortic repair following primary FET were 40.9% (n = 54) and 3.8% (n = 5), respectively. The median time to reintervention was 86 (30–439) days. The median follow-up time was 25 (8–52) months, and overall survival rates at 1, 2, and 3 years were 89%, 89%, and 87%, respectively. Conclusions: Our data are consistent with current reports, indicating that the FET technique is a valuable adjunct in treating extensive aortic arch pathologies. The procedure provides an increasingly safe and effective option for complete aortic arch replacement, even in patients requiring a redo procedure.

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