Island versus Branched Strategy in the Frozen Elephant Trunk Technique—A Propensity Score Matched Analysis

Background: For reimplantation of the supra-aortic vessels in total arch replacement using the frozen elephant trunk technique, either the en bloc “island” or separate “branched” graft strategy may be performed. The latter has been proposed to have technical advantages over the classical island technique. This study compares both techniques in terms of surgical aspects and postoperative outcomes.

Methods: From 01/2010 to 12/2022, all patients who underwent total arch replacement with the frozen elephant trunk technique for pathologies involving the aortic arch were included. Aortic pathologies comprised acute dissection (type A, non-A-non-B), chronic dissection (type A, non-A-non-B), and arch aneurysm. Patients were divided into two groups according to the surgical technique for reimplantation of the supra-aortic vessels (island versus branched). Propensity score matching based on preoperative variables was performed. After this, the groups were compared in terms of surgical aspects and postoperative outcomes.

Results: A total of 216 patients received total arch replacement with the frozen elephant trunk technique (island n = 59 versus branched n = 157). Three different frozen elephant trunk prostheses were used during the study period. After matching, 88 patients comprised the final study cohort (island n = 44 versus branched n = 44) and showed no significant differences in terms of preoperative variables including aortic pathologies and previous cardiac surgery: acute dissection 32% versus 30% (p = 0.820), chronic dissection 14% versus 11% (p = 0.751), arch aneurysm 54% versus 59% (p = 0.671), and previous cardiac surgery 27% versus 30%. Caudal circulatory arrest time was longer in the island group with 56 (43–73) compared with 52 (41–57) minutes in the branched group (p = 0.032). Thirty-day mortality and incidence of new stroke was 14 and 2% in the island group versus 23 and 0% in the branched group and did not differ significantly (p = 0.274, p = 0.320). One-year survival did not differ significantly (p = 0.390).

Conclusion: Both techniques show comparable postoperative outcomes. The branched technique may be associated with a shorter caudal circulatory arrest time.