Twelve Years of Frozen Elephant Trunk Repairs for Complex Aortic Pathologies: A Single Centre Experience in 110 Consecutive Patients

Objective: Our aim was to evaluate our overall institutional experience with the frozen elephant trunk (FET) technique for complex aortic pathologies using the Jotec Evita Open hybrid prosthesis.

Methods: From August 2005 to May 2017, 110 consecutive patients underwent a FET repair for following indications: Type A aortic dissection (AD) (total n = 42, acute n = 32, chronic n = 10), Type B AD (total n = 16, acute n = 6, chronic n = 10), and aortic aneurysm (AA) (total n = 52, elective n = 48, urgent n = 4). Mean age was 60 ± 13 years, 57% were male gender. In all patients a Jotec Evita Open hybrid graft (Hechingen, Germany) was used.

Results: Overall in-hospital mortality was 9%, 10% for AD and 8% for AA. Stroke and spinal cord injury occurred in 6% and 4%, respectively. Six patients (6%) were discharged with permanent neurologic deficits. Univariate analysis identified compromised preoperative hemodynamics, preoperative malperfusion or stroke, peripheral artery diseases, and age at surgery > 70 years as risk factors for an increased perioperative mortality. Five patients (4%) underwent planed secondary endovascular completion due to aneurysm distal to the hybrid graft, which could not be completely excluded by the primary FET procedure. Eleven patients (10%) required a secondary surgical thoraco-abdominal repair. During the follow up period of 52 ± 41 months significant endoleak formation requiring endovascular re-intervention was observed in 12 patients (11%) (Type Ia n = 1, Type Ib n = 9, Type II n = 2). The 1-, 3- and 5-year mortality rate was 9% (10/110), 18% (12/66) and 36% (19/52) respectively. During follow up, four patients (3.6%) died of aortic related reasons (two aortic rupture, one aorto-bronchial fistula and one aorto-esophageal fistula).

Conclusions: The FET technique is a feasible therapeutic option for the treatment of complex aortic pathologies involving the aortic arch and proximal descending aorta. Moreover, if an additional intervention of the downstream aorta is required, the stent graft of the hybrid prosthesis offers an ideal landing zone for secondary endovascular or surgical repair.