Incidence and Risk for Distal Aortic Failure after the Frozen Elephant Trunk Procedure

Background: Aim of this study was to identify risk factors for distal aortic failure after total aortic arch replacement using the frozen elephant trunk (FET) procedure.

Method: One hundred eighty-six patients underwent the FET procedure for acute and chronic aortic dissection. We divided our cohort into patients with and without distal aortic failure. Distal aortic failure was defined as follows: (1) distal aortic reintervention, (2) aortic diameter dilatation to ≥6 cm or >5 mm growth within 6 months, (3) development of a distal stent-graft–induced new entry (dSINE), and/or (4) aortic-related death. Preoperative, intraoperative, postoperative as well as aortic morphological data were analyzed.

Results: Distal aortic failure occurred in 88 (47.3%) patients. Forty-six (24.7%) required a distal reintervention, aortic diameter dilatation was observed in 9 (4.8%) patients, a dSINE occurred in 22 (11.8%) patients and 11 (6.4%) suffered an aortic-related death. No difference was found regarding the total number of communications between true and false lumen (p = 0.25), but there were significantly more communications between Ishimaru zones 6 to 8 in the distal aortic failure group (p = 0.01). The thoracic descending aorta´s volume measured preoperatively and postoperatively within 36 months afterwards was significantly larger in patients with distal aortic failure (p < 0.001; p = 0.011). Acute aortic dissection (SHR: 2.111; p = 0.007), preoperative maximum descending aortic diameter (SHR: 1.029; p = 0.018) and preoperative maximum aortic diameter at the level of the diaphragm (SHR 1.041; p = 0.012) were identified as risk factors for distal aortic failure.

Conclusion: The incidence and risk of distal aortic failure after the FET procedure is substantial. Especially those patients with more acute and more extensive aortic dissections or larger preoperative descending aortic diameters carry a higher risk of developing distal aortic failure. The prospective of the FET technique as a single-step treatment for aortic dissection seems low and follow-up in dedicated aortic centers is therefore paramount.

Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2023