The Frozen Elephant Trunk Technique for the Treatment of Acute and Chronic Type B Aortic Dissection

Objectives: Aim of this study was to evaluate early and mid-term outcomes of patients with acute complicated or chronic Type B aortic dissection who were treated with the frozen elephant trunk (FET) technique.

Methods: Between January 2015 and February 2019, 41 patients with acute complicated (n = 29) or chronic (n = 12) Type-B aortic dissection were treated with the FET technique. Acute aortic dissection was diagnosed when the onset of symptoms occurred fewer than 14 days before the clinical presentation. The FET technique was the treatment of choice when supra-aortic vessel transposition was unable to create a sufficient proximal landing zone for endovascular aortic repair, when a concomitant ascending or arch aneurysm was present, or in patients with connective tissue diseases.

Results: One patient (2%) expired perioperatively secondary to complete thoracoabdominal aortic rupture. No postoperative death was observed. Four patients (10%) developed a nondisabling postoperative stroke and were discharged with no clinical symptoms (modified Rankin’s scale [mRS] 0, n = 1), with no significant disability (mRS 1, n = 2), or with slight disability (mRS 2, n = 1). No patient developed signs of spinal cord ischemia. The primary entry was closed in all patients. Follow-up was available in all patients after FET implantation (100%). Patients were followed-up for a total of 59 patient-years, with a median follow-up of 17 ± 14 months. During this period, one patient (2%) expired after 2 years (not aortic related) and 15 patients (32%) required an aortic reinterventions after 8 ± 10 months (endovascular aortic repair: n = 13; open thoraco[-abdominal] aortic replacement: n = 2).

Conclusion: The FET technique is an effective treatment option for acute complicated and chronic type-B aortic dissection in patients unfit for endovascular aortic repair. The postoperative outcome is good, but the need for aortic reinterventions is considerable. Continuous follow-up of all patients undergoing the FET procedure is essential.