Abstract
Background The initial goal of acute Type A aortic dissection (ATAAD) repair remains to get
the patient off the table safely. More extensive repair is being pushed at the index
operation with the frozen elephant trunk (FET) operation, but outcomes are suggested
to be worse. However, we hypothesize that the risk associated with the FET in ATAAD
is from the patient presenting factors rather than the operation itself.
Methods A retrospective review of a single institution prospective database from 2015 to
2021 was performed. Two cohorts were created based on the indication for FET: evidence
of radiographic malperfusion (n = 44) or clinical malperfusion (n = 31). Data were analyzed for preoperative characteristics, intraoperative characteristics,
and postoperative outcomes. Statistical univariate analysis was performed with chi-square
analysis and t-tests with significance determined at an alpha level of 0.05.
Results Preoperative characteristics were similar in each group, independent of malperfusion
markers. The intraoperative characteristics were similar, except the clinical malperfusion
group had more packed red blood cells and cryoprecipitate given. The clinical malperfusion
group had longer intensive care unit length of stay (p < 0.001), more postoperative strokes (p < 0.001), more reoperations (p <0.0001), and higher mortality rate (p = 0.0003).
Conclusion These data suggest that clinical malperfusion increases the risk of major complications
and death. However, full arch replacement with FET in the absence of clinical malperfusion
does not appear to add risk to the operation for ATAAD. Patients with increased risk
of distal degeneration should be considered for more aggressive replacement to avoid
subsequent arch replacement.
Keywords
malperfusion - total arch replacement - frozen elephant trunk
