The Effect of Zone Implantation on Outcomes in Cases of Frozen Elephant Trunk

Abstract

Introduction: The distal anastomosis in cases of frozen elephant trunk implantation using a hybrid stent graft is conventionally undertaken at zone 3. Surgeons, however, are increasingly bringing the anastomosis forward to avoid a hostile arch pathology. This will result in a varying length of coverage of the descending thoracic aorta which may have implications on outcomes. The purpose of this study is to assess the effect of the zone of implantation on early outcomes after Frozen Elephant Trunk as well as mid-term survival. Methods:•Patient cohort: December 2008 to October 2017•Number of patients: 73 consecutive patients underwent Frozen Elephant Trunk implantation•51% males; 73% hypertensive•55% urgent or emergency cases•47% of patients required concomitant procedures (Valve replacement or Coronary Bypass Grafts)•18 zone 0 implantations; 3 zone 1; 15 zone 2; and 37 zone 3.•15 Evita and 58 Thoraflex hybrid; 15 cm stent portion in all patients. Reimplantation of Left Subclavian Artery in every patient.•Hypothermic circulatory arrest in all patients at 22 degrees C as well as selective antegrade cerebral perfusion.•No spinal drains were used intra-operatively. Results:•In-Hospital mortality 9.6%.•Stroke 15%•Permanent paraplegia 0% (1 patient sustained temporary paraparesis which resolved following spinal drain insertion).•9.6% Renal impairment with hemofiltration.•There was no significant difference in early outcomes when comparing zones of implantation Conclusion:•Frozen Elephant Trunk implantation during total arch replacement offers good results with acceptable mid term outcomes.•Our results show excellent rate of freedom from paraplegia which may be explained by the temperature levels during hypothermia and re implantation of LSCA.•The zone of implantation did not show to have an impact on early or mid term outcomes and therefore degree of arch resection should be tailored to every patient.•Our study was limited by small sample size, contemporary cohort with short follow up and retrospective nature. Disclosure: Nothing to disclose