A Frozen Elephant Trunk Technique to Reduce Circulatory Arrest Time in Hybrid Aortic Arch for Acute Aortic Dissection

Objective: This study compared the results of the conventional Frozen Elephant Trunk (FET) technique with those of a new approach for the treatment of Acute Aortic Dissection (AAD). Summary Background Data: Frozen Elephant Trunk has revolutionized the treatment of extensive aortic pathologies. Hypothermic circulatory arrest is a recommendation for its implementation but remains the greatest burden. Our approach for the FET (Simplified Delivery-FET) procedure allows distal suturing in normothermia with a shorter circulatory arrest time. Methods: This was a non-randomized, multicenter, retrospective study of all patients who underwent total arch replacement for AAD using either the normothermia (SD-FET) or conventional FET (control) techniques. The primary endpoints were in-hospital mortality, stroke, and spinal cord injury. Results: One hundred and fifty-three patients were included (n=90 SD-FET; n=63 control FET). Overall, in-hospital mortality was 13.3% (n=20), 10.3% (n=9) in the SD-FET group and 27.5% (n=11) in the control FET group ( P =0.206). There were no differences in the rates of postoperative stroke and spinal cord injury. SD-FET was protective for combined outcome (death and/or neurological event) with a corresponding population-average percentage of events of 17.8% (5.3–27.7) in the SD-FET group versus 30.7% (16.5–52.8) in the FET group. The Kaplan-Meier showed a survival rate at 12 and 24 months of 87% in the SD-FET group versus 83% in the FET group and 86% in the SD-FET group versus 80% FET ( P =0.625), respectively. Conclusions: The SD-FET technique allows hybrid arch surgery to be performed without cooling and is associated with a lower incidence of the combined criteria of death and/or neurological events.