Abstract
Objective Spinal cord injury (SCI) with subsequent paraplegia and/or stroke after arch repair
with frozen elephant trunk (FET) remain the most devastating complications. In this
study, we aim to examine the impact of different cerebral perfusion strategies on
the neurological outcome comparing bilateral antegrade cerebral perfusion (bACP) and
trilateral antegrade cerebral perfusion (tACP).
Methods Between 2009 and 2021, 88 patients underwent total arch replacement using a hybrid
prosthesis in FET technique for acute (40.4%) and chronic (59.6%) aortic pathologies.
After excluding 14 patients who underwent FET with unilateral ACP the remaining 74
patients were divided into two groups. Propensity score matching was performed based
on pre- and perioperative patient characteristics resulting in 22 patients in each
group. The primary endpoint was a combination of major cerebral event and SCI. Secondary
end point was all-cause mortality.
Results Major cerebral events occurred in 9% of the patients in bACP versus 13.6% in tACP
group (p = 0.63). No postoperative SCI was observed in patients with bACP and only one patient
suffered SCI with tACP (p = 0.31). There was no significant difference in 30-day mortality between the two
groups (22.7% in bACP vs. 13.6% in tACP; p = 0.43).
Conclusion In patients undergoing total aortic arch repair using FET technique, both perfusion
strategies (bilateral and trilateral ACP) are safe and effective. The rates of neurological
complications as well as mortalities are acceptably low in both groups. Further studies
with larger patient cohorts are warranted.
Keywords
frozen elephant trunk - antegrade cerebral perfusion - spinal cord protection - aortic
arch surgery
