The Frozen Elephant Trunk Technique Is Safe after Previous Aortic Repair

Objectives: The aim of this study was to evaluate operative details and outcomes of patients undergoing aortic arch replacement using the Frozen Elephant Trunk (FET) technique as an aortic reintervention after previous proximal or distal aortic intervention for aortic dissection.

Methods: Ninety-seven patients (median age was 61 [54; 69] years; 71% male) were operated on for acute as well as chronic aortic dissection using the FET technique. Of those, 52 patients had previous distal or proximal aortic interventions (R+ group) and 45 did not (R− group). Indications for total arch replacement, intraoperative details, clinical outcome, and follow-up were evaluated. A logistic regression model was performed to identify a risk factor for mortality.

Results: Time between index procedure and FET was 67 (18; 177) months. Previous proximal aortic surgery was seen in 48 (92%) patients and supracoronary ascending replacement was the most frequent index procedure (n = 27 [52%]). Distal aortic interventions were performed previously in 7 (17%) patients including TEVAR in 5 patients (10%). In-hospital mortality was 4% (n = 2) in R+ patients and 9% (n = 4) in R− patients (p = 0.41). A disabling stoke occurred in five R+ and eight R− patients (p = 0.36). Aortic reinterventions were performed in 40% (n = 20) of R+ patients and 27% (n = 11) in R− patients. Previous aortic intervention was not a risk factor for mortality.

Conclusion: Total aortic arch replacement as redo procedure after primary aortic intervention is safe with excellent clinical outcome. The FET a suitable technique for distal extension of previous limited repair for acute type A dissection as well as proximal extension after TEVAR.