Abstract
IntroductionThe aim of this study is to compare postoperative outcomes and follow-up of two different modifications facilitating surgical technique of frozen elephant trunk (FET) procedure for complex thoracic aortic diseases - zone 0 (fixation with total arch debranching) and zone 3 (fixation with islet-shape arch repair).MethodsFrom May 2012 to December 2018, data were collected from 139 patients who had been treated with FET procedure for complex thoracic aortic diseases. According to Ishimaru arch map, patients with proximal anastomotic site of hybrid graft at zone 0 and zone 3 were grouped as Group A (n=58, 41.7%) and Group B (n=81, 58.3%), respectively. Mean age of study population was 54.7±11.4 years, and 111 patients were male (79.9%).ResultsIn-hospital mortality was observed in 20 (14.4%) patients (n=12, acute type A aortic dissection, and n=4, previous aortic dissection surgery). There was no significant difference between both groups in terms of in-hospital mortality. Four patients from Group A and three patients from Group B had permanent neurological deficit (P=0.32). Three patients from both groups had transient spinal cord ischemia (P=0.334). Although mean total perfusion time was longer in Group A, duration of visceral ischemia, when compared with Group B, was shorter (P<0.001). Five-year survival rate was 82.8% in Group A and 81.5% in Group B (P=0.876).ConclusionFET procedure is a feasible repair technique in the treatment of complex aortic diseases, providing satisfactory early results. Because of its advantageous aspects, zone 0 fixation with debranching is the preferred technique in our clinic.
Highlights
The aim of this study is to compare postoperative outcomes and follow-up of two different modifications facilitating surgical technique of frozen elephant trunk (FET) procedure for complex thoracic aortic diseases — zone 0 and zone 3
One patient of Group A treated for chronic type A aortic dissection was lost due to acute respiratory distress syndrome two years after surgery and the other Group A patient with chronic type B aortic dissection died two months after surgery due to post-dissection aneurysm rupture before scheduled thoracic endovascular repair (TEVAR)
In Group B, one of the patients treated for acute type A aortic dissection died after reoperation for type 1A endoleak from the proximal suture line of FET stent graft due to stroke eight months after the first operation
Summary
The aim of this study is to compare postoperative outcomes and follow-up of two different modifications facilitating surgical technique of frozen elephant trunk (FET) procedure for complex thoracic aortic diseases — zone 0 (fixation with total arch debranching) and zone 3 (fixation with islet-shape arch repair). The evolution of the treatment of complex aortic diseases began after the ‘elephant trunk procedure’, described by Brost, and hybrid repair methods with lower mortality rates replaced conventional surgery[1]. In the classical application of FET procedure, surgeons from Western countries generally seem to prefer total arch replacement in an islet-shape, while Asian colleagues usually prefer supra-aortic de-branching. We compared the postoperative outcomes and follow-up of the complex thoracic aortic diseases treated with FET procedure, using either fixation zone 0 with total arch de-branching, or fixation zone 3 with islet-shape arch repair
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