Key result
Total arch replacement with a frozen elephant trunk for DeBakey type 1 acute aortic dissection is associated with 10% in-hospital mortality and 88.9% aortic remodeling, though spinal cord injury risk remains at 4.3%.
Why the study?
Does total arch replacement with a frozen elephant trunk improve long-term outcomes and reduce late aneurysm formation compared to conservative surgery in patients with DeBakey type 1 acute aortic dissection?
Does total arch replacement with a frozen elephant trunk improve long-term outcomes and reduce late aneurysm formation compared to conservative surgery in patients with DeBakey type 1 acute aortic dissection?
The frozen elephant trunk technique is a promising but technically demanding approach for DeBakey type 1 acute aortic dissection that may improve distal aortic remodeling and reduce the need for late reinterventions.
Hypothesis-generating for frozen elephant trunk in type 1 dissection; prospective trials needed before changing practice.
The surgical management of patients with DeBakey type 1 acute aortic dissection (DBT1-AAD) represents a major challenge for aortic surgeons. It has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing DBT1-AAD surgery and that a patent false lumen worsens the prognosis. In order to improve long term outcomes and reduce the frequency of late aneurysm formation and reoperation, a more aggressive primary operation involving total arch replacement (TAR) and concomitant antegrade stenting of the descending thoracic aorta (DTA) with a frozen elephant trunk (FET) has been introduced. Such extensive operations, however, remain controversial due to their increased technical complexity and perceived higher operative mortality and morbidity. This perspective article will overview the rationale behind, and the potential advantages and current evidence for, FET surgery in acute aortic dissection.
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Berretta et al. (2016) conducted a review in DeBakey type 1 acute aortic dissection. Total arch replacement with frozen elephant trunk (FET) vs. Conservative tear-oriented aortic replacement was evaluated. Total arch replacement with a frozen elephant trunk for DeBakey type 1 acute aortic dissection is associated with 10% in-hospital mortality and 88.9% aortic remodeling, though spinal cord injury risk remains at 4.3%.
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