A Comparison of Frozen Elephant Trunk, Aortic Balloon Occlusion, and Hybrid Repair for Total Arch Replacement

Abstract

This study aimed to compare clinical outcomes of patients treated by total arch replacement (TAR) with frozen elephant trunk (FET), aortic balloon occlusion (ABO) technique and hybrid arch repair (HAR). Between January 2017 and July 2019, 643 consecutive patients with aortic arch diseases were eligible for TAR, including 356 in conventional FET, 112 in ABO based on FET, and 175 in HAR. A retrospective cohort analysis of perioperative results was undertaken, performed with inverse probability weighting. The primary endpoint was composite endpoints included 30-day mortality, stroke, paraplegia, hemodialysis, reintubation, and intra-aortic balloon pump or extracorporeal membrane oxygenation support, and visceral dysfunction was secondary endpoint. Overall in-hospital mortality was 2.2% (FET = 2.5% vs ABO = 0 vs HAR = 2.9%, P= 0.210). Parallel early outcomes were demonstrated among three groups. ABO group was associated with significantly shorter circulatory arrest time (5, IQR 3-7 vs 16, IQR 14-18 minutes, P < 0.001), and a lower incidence of visceral dysfunction compared with FET group (25.1% vs 47.3%, P= 0.003). Patients receiving ABO suffered a significantly lower rate of prolonged ventilation (more than 72 hours; P= 0.014). Furthermore, a tendency toward decreasing composite endpoints was suggested in ABO (7.2%) compared with FET (15.5%, P= 0.061) and HAR (19.8%, P= 0.032). ABO technique obtains considerable early clinical outcomes for TAR compared with conventional FET and HAR, which could be a feasible and effective approach for patients with aortic arch diseases.