Abstract
Background Repeat surgery of the chronically dissected aorta following repair of a Type-A acute
aortic dissection (AAD) still represents a challenge. The proposed surgical options
are as follows: (1) staged procedure with elephant trunk (ET) technique, (2) traditional
frozen elephant trunk (FET) intervention, and (3) beating heart cerebral vessel debranching
followed by thoracic endovascular aortic repair (TEVAR). However, a marked enlargement
of the proximal descending thoracic aorta might make it difficult to perform FET/ET
intervention. Furthermore, because in conventional surgery for AAD, a prosthetic graft
replacement is generally limited to the ascending aorta, and in repeat surgery, this
short Dacron graft rarely provides enough room to allow a beating heart cerebral vessel
debranching and obtaining a reliable landing zone for the implantation of a firmly
anchored stent graft.
Methods We retrospectively reviewed all the five consecutive patients treated in our institution,
between 2014 and 2017, for chronic aortic dissection after successful surgical treatment
of acute Type-A aortic dissection with graft replacement limited to the ascending
aorta. The five patients underwent repair utilizing a modified FET technique with
total aortic arch and upper descending aorta exclusion without touching the native
dissected aorta.
Results No early- or midterm mortality was observed. Mean time interval between the initial
and the reoperative procedure was 26 months (range, 3–80 months). No patient had a
minor/major neurologic event. Mean circulatory arrest time was 16 minutes (range,
11–25 minutes). Mean follow-up time was 22 months (range, 9–42 months).
Conclusions We report our initial experience with a modified FET technique realized by anastomosing
the stent graft with the previously implanted ascending aortic graft in Hishimaru's
zone 0 and by rerouting all cerebral vessels without “touching” the native chronically
dissected aorta. A larger number of patients and a longer follow-up will be required
to confirm these initial encouraging results.
Keywords
aortic dissection - repeat surgery - frozen elephant trunk technique
