Efficacy of total arch replacement with frozen elephant trunk for type B aortic dissection involving left subclavian artery-adjacent entry: a strategy for anatomically challenging cases.

OBJECTIVE

To evaluate the feasibility and safety of total arch replacement with a frozen elephant trunk in patients with Stanford type B aortic dissection and an entry ≤ 10 mm distal to the left subclavian artery.

METHODS

We retrospectively reviewed 40 consecutive patients who underwent either total arch replacement with a frozen elephant trunk (n = 30) or thoracic endovascular aortic repair (n = 10). The primary outcome was late all-cause mortality. Secondary outcomes included major complications, planned additional endovascular repair after total arch replacement with a frozen elephant trunk, false lumen thrombosis, and aortic remodeling.

RESULTS

In the thoracic endovascular aortic repair group, procedure-related complications occurred, including retrograde type A dissection and one death from aortic rupture. In the total arch replacement with a frozen elephant trunk group, all deaths were unrelated to the index procedure. Planned additional endovascular repair was more frequently performed after total arch replacement with a frozen elephant trunk.

CONCLUSIONS

Total arch replacement with a frozen elephant trunk is safe for anatomically challenging type B aortic dissection with an entry near the left subclavian artery and represents a viable treatment option in this setting.