Is Total Aortic Arch Replacement with Frozen Elephant Trunk Procedure in Septuagenarians Justified?

Objectives: Total aortic arch replacement is an invasive procedure with significant risks for complications. We present our experience with total aortic arch replacement using the frozen elephant trunk (FET) technique in septuagenarians and compared the results with those of younger patients.

Methods: We identified a total of 199 patients who underwent elective FET procedure between August 2001 and December 2018. Patients were assigned to either group A (age >  70 years) or to group B (age < 70 years). There were 64 patients in group A (mean age: 74 ± 4 years) and 135 patients in group B (mean age: 56 ± 11 years).

Results: Perioperative outcome is shown in the [Table-1]. Follow-up was complete on 100% of patients with a mean follow up time of 4.6 ± 4.3 years. The 1- and 5-year survival rates were 70 and 55% in group A, and 87 and 77% in group B, respectively (log rank: p < 0.001).

Table 1 Perioperative outcomes in groups A and B

	Group A (> 70 years, n = 64)	Group B (<70 years, n = 135)	p-Value
CPB time (min)	214 ± 64	242 ± 74	0.008
Myocardial ischemia time (min)	109 ± 54	123 ± 65	0.132
Circ. arrest time (min)	52 ± 29	52 ± 27	0.919
Rethoracotomy (%, n)	17 (11)	13 (18)	0.442
Temporary dialysis (%, n)	30 (19)	14 (18)	0.007
Permanent dialysis (%, n)	2 (1)	1 (2)	0.975
Paraplegia (%, n)	2 (1)	1 (2)	0.975
Stroke (%, n)	19 (12)	12 (16)	0.213
Tracheostomy (%, n)	28 (18)	14 (19)	0.020
ICU stay (d)	12 ± 15	7 ± 9	0.029
Hospital mortality (%, n)	20 (13)	8 (11)	0.014

Conclusion: Total aortic arch replacement with FET has a significantly higher risk for perioperative morbidity and mortality in septuagenarians than in younger patients. Long-term survival is significantly impaired in elderly patients. We recommend thorough patient selection in elderly patients who require total aortic arch replacement. Optimization of perioperative protective techniques seems to be desirable in order to improve early outcome.