Short- and midterm results after hybrid treatment of chronic aortic dissection with the frozen elephant trunk technique.

OBJECTIVE

The purpose of this study was to examine our experience with the frozen elephant trunk in patients with chronic aortic dissection.

METHODS

In our Institution, between January 2007 and August 2010, 49 patients (mean age: 59.6 ± 9.0 years) underwent total arch replacement with the frozen elephant trunk technique for chronic aortic dissection (type A, n=2; residual type A, n=37; type B, n=10). Forty patients (81.6%) patients had undergone previous cardiovascular procedures. Associated cardiac procedures were indicated in 21 (42.8%) patients. Brain protection was achieved with antegrade selective cerebral perfusion in all cases.

RESULTS

Hospital mortality (n=5) was 10.2%. Postoperative serious complications included coma (n=3; 6.1%), paraplegia (n=2; 4.1%), respiratory failure (n=6; 12.2%), and definitive dialysis (n=2; 4.1%). Follow-up was 100% completed (mean period: 12.9 ± 11.7 months). The estimated 1- and 3-year survival rates were 91.2 ± 4.2% and 81.6 ± 6.5%, respectively. Endovascular extension was required in 11 (22.4%) patients, with technical success of 100%. Complete thrombosis of the peri-stent false lumen was achieved in 82.9% of cases, with significant reduction of the false lumen diameter (preoperative: 36 ± 11 mm; postoperative: 24 ± 17 mm; p=0.001) and increase of the true lumen diameter (preoperative: 15 ± 5 mm; postoperative: 26 ± 6 mm; p=0.001).

CONCLUSIONS

The frozen elephant trunk technique, allowing treatment of extensive disease of the thoracic aorta, was associated with encouraging short- and midterm results. Longer-term follow-up is warranted.