Left Subclavian Artery Sacrifice in Acute Aortic Dissection Repair Using the Frozen Elephant Trunk

Objectives: Surgical repair of acute aortic dissection DeBakey type I using the frozen elephant trunk can be complicated when the origin of the left subclavian artery is ruptured and sacrifice by ligation is a valid option. However, the left subclavian artery is supposed to play a role in neuroprotection as a major collateral. We therefore analyzed our results of left subclavian artery sacrifice with regard to neurologic outcome.

Methods: This is a retrospective analysis of all consecutive patients who underwent acute aortic dissection repair using the frozen elephant trunk at our center between 2009 and 2018, n = 84. Sacrifice of left subclavian artery (LSA) was performed in n = 19 (22.6%) patients. Results were analyzed with regard to neurologic outcomes.

Result: We observed a temporary neurologic deficit in overall, n = 5 (6.0%), patients, and none in the LSA sacrifice group. New postoperative stroke was seen in overall, n = 2 (2.4%) patients, and none in the LSA sacrifice group. Spinal cord injury occurred in overall, n = 3 (3.6%), patients, and none in the LSA sacrifice group. No patient developed ischemia of the left arm. Only two patients (10.5%) needed carotid subclavian artery bypass due to exertion-induced weakness of the left arm 3 to 4 months after initial surgery. In-hospital mortality was overall 15.5%, with no difference between groups (LSA sacrifice group: 15.8%, p = 0.61).

Conclusion: LSA sacrifice does not elevate the perioperative risk of neurologic injury, neither central nor spinal and can be suggested as a valid solution in FET repair of acute aortic dissection. Carotid subclavian artery bypass is necessary in only a small fraction of these patients and can be performed easily two-staged.

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

Publication History

Article published online:
19 February 2021