The frozen elephant trunk technique for retrograde acute type A aortic dissection

Abstract

The operative strategies for retrograde acute type A aortic dissection with a primary intimal tear remain controversial because resection of an intimal tear via a median sternotomy is difficult. We evaluated the frozen elephant trunk technique for treating this type of aortic dissection. The frozen elephant trunk technique was used for acute retrograde type A aortic dissection with a primary intimal tear in the descending aorta in 25 consecutive patients (16 men, 9 women; median age, 64 years) seen between 1997 and 2011 at the Hiroshima City Asa Hospital. Three patients had Marfan syndrome. Fourteen patients had ischemia of the lower half of the body, 2 had stroke, 3 had coronary ischemia, and 10 had pericardial tamponade. There were no hospital deaths. Postoperative complications occurred in 2 patients, including stroke and mediastinitis. Two late deaths occurred over a median follow-up period of 58 months (12-169 months), one caused by stroke and the other by colon cancer. Two patients needed additional operations: one required a second operation for descending aorta replacement because of ulceration caused by the stent graft, and the other required an endovascular stent graft because of dilatation of the descending aorta. Computed tomography follow-up scans revealed that the false lumen was completely thrombosed and obliterated in all 25 patients with stent grafts. The frozen elephant trunk technique for retrograde type A aortic dissection yielded acceptableoutcomes, despite the high preoperative morbidity, and might improve the prognosis of dissection.