Complete-Island/Partial-Island Technique and Types of Complex Transposition for Surgical Management of Supra-Aortic Vessel Involvement during the Frozen Elephant Trunk Procedure in Acute/Chronic Type-A Aortic Dissection: Midterm Results from 158 Patients

Objectives: To evaluate the midterm results of different surgical management strategies of supra-aortic vessel involvement in acute/chronic type A aortic dissection during FET surgery.

Methods: Between 2009 and 2020, a total of 158 patients (81 males; mean age: 54.2 ± 11.5 years, range: 38.5–73.4 years) were treated with the frozen elephant trunk technique. Surgical management of supra-aortic vessels consisted of complete-island technique (group A; en bloc reimplantation of the innominate artery (IA)/left carotid artery (LCA) and left subclavian artery(LSA); n = 87, 55%), partial-island-technique (group B; en-bloc reimplantation of the IA/LCA and rerouting of the LSA; n = 45, 28%), and various types of complex transposition (group C; n = 26, 16%).

Result: Overall 30-day mortality was 18% (AAD: n = 24/106 (23%), CAD: n = 7/52 (13%); p = 0.29). Between three groups, no significant differences in survival-estimates could be detected. According to the three different surgical head vessel management strategies, a nonsignificant (p = 0.88) difference regarding cumulative survival is evident. Postoperative major cerebrovascular events were significantly different depending on the surgical strategy applied (p = 0.005, p = 0.002, respectively).

Conclusion: Midterm results of alternative supra-aortic vessel treatment approaches in dissection pathology during FET-surgery showed favorable neurological outcomes and 30-day mortality in group C. However, the long-term outcome of different treatment strategies of supra-aortic vessels during FET-surgery has to be evaluated.

Publication History

Article published online:
19 February 2021