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DOI: 10.1055/s-0040-1705320
Total Aortic Arch Replacement Using the Frozen Elephant Trunk Technique: Risk Factor Analysis Influencing Early Mortality
Publication History
Publication Date:
13 February 2020 (online)
Objectives: The aim of the study was to determine perioperative risk factors influencing early mortality in a single-center cohort of patients undergoing frozen elephant trunk (FET) procedure for extensive aortic aneurysms or type-A/B aortic dissection.
Methods: Between October 2010 and August 2019, a total of 118 consecutive patients (mean age: 61.9 ± 14.0 years) underwent FET surgery using moderate circulatory arrest (CA) and selective antegrade cerebral perfusion (SACP). Of these, 54 patients underwent a simplified FET technique (arch zone 2 and extra-anatomic bypass to the distal left subclavian artery during reperfusion). Patients presented with thoracic aneurysm (38.1%), acute type-A aortic dissection (27.1%), chronic dissection (33.1%), 8.5% suffered from acute aortic rupture, and 26.3% had a redo operation.
Results: Overall 30-day mortality rate was 11.0%. Permanent neurologic dysfunction was present in 14 patients (11.9%). Significant risk factors for early mortality were age > 70 years (OR = 12.2, p = 0.002), acute dissection (OR = 4.6, p = 0.013), aortic rupture (OR = 7.2, p = 0.007), malperfusion (OR = 6.0, p = 0.006), renal failure (OR = 8.1, p = 0.001), CA > 50 minutes (OR = 7.4, p = 0.012), and SACP > 70 minutes (OR = 14.9, p = 0.001). In contrast, a simplified FET technique (early mortality, 1.9%) was associated with a lower 30-day mortality risk (OR = 0.085, p = 0.02). Stepwise logistic regression identified age, malperfusion, and renal failure as independent predictors for early mortality.
Conclusion: Patients with advanced age in poor preoperative condition undergoing emergency aortic surgery showed a high 30-day mortality risk in FET surgery. The simplified FET technique was associated with a significant improved outcome.