Frozen Elephant Trunk Technique in the Elderly: Could Age Alone Be Considered as an Exclusion Criteria?

Objectives: Frozen elephant trunk (FET) surgery is a modern treatment modality which is recommended for acute and chronic aortic dissections, as well as thoraco-abdominal aneurysm. Due to a rising life expectancy and hence, an aging society, we retrospectively evaluated surgical outcomes in patients aged 70 and above.

Methods: Between October 2010 and August 2020, a total of 54 patients aged 70 and above (Group O, mean age: 74 ± 2) underwent FET. Operative outcome and survival was compared with 96 contemporary younger patients aged < 70 years (Group Y, mean age 54 ± 12). Concomitant surgical procedures were in Group O and Y: aortic root replacement (p = 0.255) 22.2% versus 22.9%, coronary bypass grafting (p = 0.037) 16.7% versus 5.2%, mitral valve reconstruction (p = 0.640) 1.0% versus 0% and tricuspid valve reconstruction (p = 0.045) 5.6% versus 0%.

Result: There were statistically significant more acute aortic syndromes (n = 31 versus 19) and chronic dissections (n = 42 versus 6) in Group Y (p = 0.001), as compared with thoraco-abdominal aneurysm as the underlying indication for surgery in Group O (n = 23 versus 29; p=ns).

Postoperatively, patients in Group O showed a higher incidence of permanent neurologic deficit (16.7% versus 5.2%; p = 0.020), acute kidney failure (24.1 vs. 10.5%; p = 0.008) and multi organ failure (11.1% versus 4.2%; p = 0.046). Postoperative ventilation time (48 ± 90 hours vs. 84 ± 177 hours; p = 0.10), stay on intensive care unit (7.3 ± 9.5 days vs. 7.0 ± 7.0 days; p = 0.86) and wound complications (2 vs. 0%, p = 0.25) did not show statistical differences.

Thirty-day mortality was significantly increased in Group O (12.22 vs. 4.17%; p = 0.001).

Conclusion: Elderly patients (Group O) showed a less favorable outcome following FET procedures than younger patients (Group Y), despite the fact that younger patients presented with more complex, life threatening pathologies. Thus, elderly patients should carefully selected for aortic arch surgery using FET and endovascular surgery might be considered in patients unfit for open repair.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021