Standardized Evaluation after Frozen Elephant Trunk Implantation According with the International Aortic Arch Surgery Study Group Recommendations

Objectives: In 2015, the International Aortic Arch Surgery Study Group (IAASSG) published predefined outcome measures with 16 variables for 6 organ systems (neurological, cardiovascular (CV), respiratory, renal, gastrointestinal (GIT) and others). This study aims to report the postoperatively outcome following FET according to the IAASSG recommendations.

Methods: Ninety-one consecutive patients (58.2% male) who underwent aortic arch and descending replacement using FET technique between October 2010 and August 2018 were evaluated. Mean age was 63.6 ± 12.5 years. Indications for surgery were: thoracic aneurysm (37.4%, n = 34), acute (28.6%, n = 26), and chronic (34.1%, n = 31) type A/B dissections. The severity of all complications was evaluated separately for each of the six organ systems and graded on a scale of I (any deviation from the normal course) to V (lethal) for each of the defined organ systems.

Results: Thirty-day mortality was 13.2% (n = 12: 3 neurological, 4 cardial, 1 lung, 2 GIT, 1 septicemia, 1 bleeding). Mean ICU stay was 6.1 ± 5.8 days and mean ventilation time was 65 ± 137 hours. Twenty-three grade IV complications were documented: 5 neurological (require ventilation > 7 d: 1 focal, 4 global, no spinal, no recurrent laryngeal nerve palsy), 8 cardial (2 pace maker implantations, 7 late tamponades), 3 lung (parenchymal), 1 GIT (required laparotomy), 3 ongoing dialysis, 2 sternal wound infection, 1 bleeding. Eighty-seven grade III complications were seen: 11 neurological (5 focal, 2 global, 4 spinal), 4 cardioversions, 15 lung (4 parenchymal, 11 chest tubes), 12 temporary dialysis, 45 others (34 required ≥4 U packed blood cells, 10 recurrent nerve palsy, 1 superficial wound infection). Grade II and grade I complications are not listed, due to their insignificant influence on the outcome.

Conclusions: IAASSG endpoints provide a valuable tool to standardize the outcome measures after FET procedures. Results can be reported in a standardized manner, making the outcome of this technique more comparable. Furthermore, the complete spectrum of the classical complications are listed and graded. For this reason the application of the IAASSG endpoints should be mandatory.