Frozen elephant trunk versus conventional proximal repair of acute aortic dissection type I

• Published in: Frontiers in cardiovascular medicine Vol. 11; p. 1326124
• Main Authors: Göbel, Nora, Holder, Simone, Hüther, Franziska, Anguelov, Yasemin, Bail, Dorothee, Franke, Ulrich
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 2024
• Subjects: aortic arch surgery; aortic dissection type I; frozen elephant trunk; long-term outcomes; mortality; neurologic deficit; aortic dissection type I; mortality; frozen elephant trunk; reintervention; aortic arch surgery; long-term outcomes; neurologic deficit
• ISSN: 2297-055X; 2297-055X
• DOI: 10.3389/fcvm.2024.1326124

The extent of surgery and the role of the frozen elephant trunk (FET) for surgical repair of acute aortic dissection type I are still subjects of debate. The aim of the study is to evaluate the short- and long-term results of acute surgical repair of aortic dissection type I using the FET compared to standard proximal aortic repair. Between October 2009 and December 2016, 172 patients underwent emergent surgery for acute type I aortic dissection at our center. Of these,  = 72 received a FET procedure, while the other 100 patients received a conventional proximal aortic repair. Results were compared between the two surgery groups. The primary endpoints included 30-day rates of mortality and neurologic deficit and follow-up rates of mortality and aortic-related reintervention. Demographic data were comparable between the groups, except for a higher proportion of men in the FET group (76.4% vs. 60.0%,  = 0.03). The median age was 62 years [IQR (20),  = 0.17], and the median log EuroSCORE was 38.6% [IQR (31.4),  = 0.21]. The mean follow-up time was 68.3 ± 33.8 months. Neither early (FET group 15.3% vs. proximal group 23.0%,  = 0.25) nor late (FET group 26.2% vs. proximal group 23.0%,  = 0.69) mortality showed significant differences between the groups. There were fewer strokes in the FET patients (FET group 2.8% vs. proximal group 11.0%,  = 0.04), and the rates of spinal cord injury were similar between the groups (FET group 4.2% vs. proximal group 2.0%,  = 0.41). Aortic-related reintervention rates did not differ between the groups (FET group 12.1% vs. proximal group 9.8%,  = 0.77). Emergent FET repair for acute aortic dissection type I is safe and feasible when performed by experienced surgeons. The benefits of the FET procedure in the long term remain unclear. Prolonged follow-up data are needed.