Total Aortic Arch Replacement with the Frozen Elephant Trunk after Previous Repair for Type-A Aortic Dissection

Objectives: Total aortic arch replacement is a complex operation with a high risk for potential morbidity and mortality. Previous surgical repair for type-A aortic dissection may increase this risk even more. In this study, we present our experience with total aortic arch replacement using the frozen elephant trunk technique (FET) in patients with prior surgery for type-A aortic dissection.

Methods: Between 08/2001 and 12/2018, a total of 347 operations with the frozen elephant trunk procedure were performed at our center, of which 52 were re-do cases for chronic aortic dissection type A (CADA). The mean age of these patients was 57 ± 14 years, and 75% (n = 39) were male. Marfan’s syndrome was present in 21% (n = 11). We performed a retrospective analysis with follow-up.

Results: The in-hospital mortality rate was 8% (n = 4) in redo cases for chronic type-A dissection, whereas the overall in-hospital mortality rate for the entire cohort was 14% (p = 0.241). The rates for permanent neurological deficit, temporary spinal cord injury, permanent spinal cord injury, and new dialysis were 14% (n = 7), 4% (n = 2), 0% (n = 0), and 2% (n = 1), respectively. Follow-up was complete on 100% of patients with a mean time of 5.8 ± 4.7 years. During follow-up, there were 11 late deaths in CADA patients. No significant difference was found between survival of CADA patients and non-CADA patients (p = 0.23).

Conclusion: Total aortic arch replacement is a complex procedure, which can be performed safely even in cardiac reoperations for chronic type-A dissection. Despite redo surgery, perioperative mortality seems to be comparable to nonchronic type-A dissection patients. Previous cardiac surgery does not seem to increase the perioperative risk significantly. Although redosurgery for CADA has acceptable results, usage of the FET should be considered at the time of the initial type-A dissection.