Frozen Elephant Trunk Procedure as an Alternative Method of the Treatment in Patients with Aortic Dissection Type B and Concomitant Aortic Arch or Ascending Aortic Pathology

Eduard R. Charchyan, Denis G. Breshenkov, Alexey A. Skvortsov, Yurii V. Belov

Federal State Scientific Institution Russian Scientific Center of Surgery named after Academician BV Petrovsky, Moscow, Russia

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–B

Abstract

Objective: to analyse the methods of surgical treatment of type B aortic dissection with concomitant pathology of aortic arch or ascending aorta and to present our experience with hybrid approach using Frozen Elephant Trunk technique.

Methods: From January 2013 to December 2017 53 patients underwent Frozen Elephant Trunk procedure: 11 patients underwent treatment for type B aortic dissection (with aortic arch involved in 6 cases, concomitant aneurysm of ascending aorta or aortic root with AI ≥ 2 – 5). Men age was 51,3±8,2 years, 10 patients were with chronic dissection. Surgical treatment was performed through full median sternotomy, circulatory arrest and selective antegrade bilateral cerebral perfusion. Primary end points were hospital mortality, 1-year mortality. Secondary end points included complications, reintervention, and aortic remodeling.

Results: In-hospital and 1-year mortality was 0%, 1-year. Mean stay in intensive care unit was 15 days. Mean duration of cardiopulmonary bypass was 166±27 min, aortic clamping – 93 ± 23 min, circulatory arrest time – 43 ± 11 min.Perioperative morbidity included stroke in one patient, subdural hematoma also in one patient, two patients underwent reexploration for bleeding. In one case dSine was observed (9%) after 3 years after operation and 1 patients required secondary aortic endovascular reintervention in follow-up time in 10 months after primary surgery.

Conclusions: FET is an alternative method for treatment of combined proximal aortic and aortic arch pathology and type B dissection that allows one-stage treatment. This procedure reduces the rate of second stage interventions. Further close follow-up and research are necessary in order to determine the optimal method of surgical treatment in this cohort patients.