Midterm Outcomes of Total Arch Replacement with the Frozen Elephant Trunk Technique: A Single-Center Experience

Objectives: The frozen elephant trunk technique has facilitated the treatment of various aortic arch pathologies. We describe herein our midterm results having a focus on aortic remodeling.

Methods: Between March 2017 and December 2019, a total of 29 consecutive patients underwent total arch replacement for various indications employing the frozen elephant trunk technique. Direct cannulation of the right axillary artery and selective unilateral or bilateral cerebral perfusion under moderate systemic hypothermic circulatory arrest was used in all patients. Each patient underwent CT scan before discharge and imaging follow-up was performed at 6 to 12 months after surgery and annually thereafter. To evaluate aortic remodeling, we detected the status of the false lumen and measured the growth rate of the distal descending aorta. In-hospital mortality was 3% (n = 1), and follow-up was 96% (27/28) with a median period of 18 months. 92% (25/27) showed sufficient image data for analysis.

Result: Complete thrombosis of the false lumen was achieved in 84% (n = 21). 16% (n = 4) showed a patent false lumen with progression in aortic diameter. Reintervention rate (TEVAR) was 16% (n = 4). Patients with a thrombosed false lumen showed a significantly decrease in aortic diameter compared with those with a patent false lumen (-6 versus +3 mm per year; p < 0.05). No patient died during follow-up.

Conclusion: Our institutional data shows using the frozen elephant trunk technique strongly induce false lumen thrombosis leading to positive aortic remodeling. The FET concept reduces the necessity for further operations. Furthermore, our low short and mid-term mortality rate suggests that this approach can safely be applied.

Publication History

Article published online:
19 February 2021