Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk techniques: Results of a multicenter study

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Leontyev S. 1, Tsagakis K. 2, Pacini D. 3, Grabenwoeger M. 4, Sioris T. 5, Mestres C. 6, Mohr F. W.1, Jakob H. 2

1Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany; 2Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, Essen, Germany; 3Department of Cardiac Surgery, Sant’Orsola-Malpighi Hospital, Bologna, Italy; 4Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria; 5Tampere University Hospital Heart Center; 6Department of Cardiovascular Surgery, Hospital Clínico, University of Barcelona, Barcelona, Spain;

Objective:
Treatment of patients with extensive thoracic aortic disease involving the arch and descending aorta is often performed using the frozen elephant trunk technique (FET). We retrospectively analysed early outcome with this technique and associated factors using a prospective database.

Methods:
Between 2005 and January 2014 509 patients (mean age 61±11 years) have been registered in a multicentre database after FET surgery. Acute or chronic aortic dissection (AD) was the indication for surgery in 350 (68.8 %) and degenerative or atherosclerotic aneurysm (DA) accounted for 159 (31.2 %) patients. A logistic regression model was created to identify independent predictors of in-hospital mortality and neurological complications. Results: In-hospital mortality was 15.9 % (n=81); 17.1 % for AD and 13.2 % for DA patients (p=0.2). Independent predictors of hospital mortality were hemodynamic instability (OR 2.7, p=0.005), peripheral vascular disease (OR 2.6, p=0.002), diabetes (OR 2.1, p=0.05) and selective cerebral perfusion more than 60 minutes (OR 2.2, p=0.005). Age under 60 years and the use of guide wire by FET implantation were protective for early survival. Stroke occurred in 8.1 % (n=41). Paraplegia or paraparesis occurred in 7.5 % (n=38). A distal landing zone lower than T 10 was an independent predictor for spinal cord injury (OR 2.1, p=0.04).

Conclusions:
Techniques for faster arch replacement and controlled FET placement should be considered in order to reduce the early mortality and neurological complications after FET surgery. For distal aortic lesions a two-staged approach rather than FET landing lower as T 10 is suggested.

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