Thorac Cardiovasc Surg 2020; 68(S 01): S1-S72
DOI: 10.1055/s-0040-1705318
Oral Presentations
Sunday, March 1st, 2020
Aortic disease
Georg Thieme Verlag KG Stuttgart · New York

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

E. Beckmann
1   Hannover, Germany
,
A. Martens
1   Hannover, Germany
,
H. Krüger
1   Hannover, Germany
,
A. Stettinger
1   Hannover, Germany
,
T. Kaufeld
1   Hannover, Germany
,
W. Korte
1   Hannover, Germany
,
A. Haverich
1   Hannover, Germany
,
M. L. Shrestha
1   Hannover, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2020 (online)

 
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    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.


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    No conflict of interest has been declared by the author(s).

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