Early Outcome of Frozen Elephant Trunk Procedures as Redo Operation

Objectives: The frozen elephant trunk (FET) procedure is a treatment of patients with extensive thoracic aortic disease. Despite modern cerebral perfusion strategies, due to the complex surgical technique, early mortality rates are high ranging from 6.4 to 15.8%. As patients with DeBakey Type I dissections are primarily treated with nonstented grafts in many centers, subsequent redo operations due to residual dissections are frequently necessary. Therefore, we sought to identify prevalence and outcome of patients undergoing FET procedures as redo operation.

Methods: Ninety-two consecutive patients who underwent FET surgery between October 2010 and August 2018 at our center were registered in a dedicated database and retrospectively analyzed. Clinical and follow-up characteristics were compared between patients undergoing FET as primary (primary group) or redo procedure (redo group).

Results: In this study, 23.9% (n = 22) of the procedures were redo operations (redo group).

Patients in the redo group were significantly younger when compared with patients receiving primary surgery (66.2 ± 11.6 years vs. 54.6 ± 12.1; p < 0.001). The EuroSCORE II did not significantly differ between the groups (primary group: 14.0 ± 13.6; redo group: 10.0 ± 9.4; p = 0.323). Patients of the redo group suffered from genetic aortic syndrome (GAS) more frequently (5.7% [n = 4] vs. 54.5% [n = 12]; p < 0.0001).

There was no significant difference in the occurrence of postoperative acute kidney failure (primary group: 18.8% [n = 13]; redo group: 10.0% [n = 2]; p = 0.505), recurrence nerve palsy (primary group: 13.6% [n = 8]; redo group: 33.3% [n = 7]; p = 0.058), paraparesis (primary group: 2.9% [n = 2]; redo group: 0.0% [n = 0]; p = 1.000), transient neurological deficit (primary group: 2.9% [n = 2]; redo group: 0.0% [n = 0]; p = 1.000), and postoperative stroke (primary group: 12.9% [n = 9]; redo group: 4.5% [n = 1]; p = 0.442).

Although not statistically significant, the 30-day mortality rate was three times higher in the primary group (15.7% [n = 11] vs. 4.5% [n = 1]; p = 0.281). The one case of death after redo surgery occurred on postoperative day 18 due to acute pancreatitis after an uneventful postoperative period, which was unrelated to the surgical technique.

Conclusion: Redo FET procedures are mainly performed in relatively young patients frequently suffering from GAS. Our data demonstrate an adequate safety profile of FET procedures performed as redo operation.