Outcomes after Reoperative Open Aortic Arch Replacement in Patients with Residual Type A Aortic Dissection

Background: Aim of this study was to analyze postoperative outcomes following reoperative total arch replacement via frozen elephant trunk (FET) implantation for the treatment of residual type A aortic dissection.

Methods: Between 04/2015 and 10/2023, 58 patients were treated with elective redo surgical total arch repair using the FET technique following emergent ascending or hemi-arch replacement for acute type A aortic dissection in one aortic center. Clinical data and postoperative outcomes were analyzed.

Results: The time from acute type A dissection repair to FET implantation was 6 (first quartile: 2; third quartile: 10) years. Median age at FET implantation was 62 (55, 71) years. At that time, all patients (100%) presented with supra-aortic vessel dissection. The right subclavian artery was the preferred arterial cannulation site in 52 patients (90%). Zone 2 was the preferred implantation zone in 50 patients (86%). Concomitant cardiac and/or aortic procedures were performed in 20 patients (34%): valved conduit (n = 9, 16%), valve-sparing root replacement (n = 4, 7%), CABG (n = 4, 7%), aortic valve replacement (n = 4, 7%). The beating heart technique was used in 18 patients (31%). Median cardiopulmonary bypass time was 209 (172, 245) minutes and median cross-clamp time was 115 (89, 162) minutes. Postoperatively, 4 patients (7%) presented with a disabling stroke (modified Ranking scale >2), 1 patient (2%) with a non-disabling stroke, and 3 patients (5%) expired in-hospital. No variable, including cardiopulmonary bypass time (p = 0.586), was predictive for in-hospital death in our multivariable logistic regression analysis.

Conclusion: Reoperative total arch replacement using the FET technique for the treatment of residual type A aortic dissection demonstrates excellent outcome in this study. Further multi-center or prospective studies are necessary to optimize the second step treatment of a residually dissected aortic arch by the aortic team.

Publication History

Article published online:
11 February 2025