Hans Georg Borst Preis: Midterm Results with the Frozen-Elephant Trunk Technique (E-vita Open) in Thoracic Aortic Disease: A Single-Center Experience in 199 Patients

Objectives: The frozen-elephant trunk (FET) technique is performed to achieve one-stage treatment of the proximal and distal thoracic aorta in different pathologies: acute (AAD) or chronic (CAD) type I aortic dissection and degenerative thoracic aortic aneurysms (TAA). We demonstrate our midterm results up to 10 years.

Methods: Between January 2009 and January 2019, a total of 199 patients (mean age: 64 ± 21 years) were treated with the FET for AAD (n = 88), CAD (n = 50), TAA (n = 61). Pre-/intra- and postoperative data and follow-up results including aortic remodeling and reintervention rates are presented.

Results: Overall 30-day mortality was 15%–20% for AAD, 14% for CAD, and 7% in TAA. Univariable analysis identified peripheral arterial disease, instable hemodynamics, aortic x-clamp time, and diameter size of the proximal descending aorta as risk factors for 30-day mortality. After 5 years, estimated survival was 55% in AAD, 59% in CAD, and 78% in TAA. Freedom from endovascular intervention downstream at 5 years was 72% in AAD, 74% in CAD, and 51% in TAA patients. Freedom from thoraco-abdominal surgery was 97, 92, and 93%, respectively.

Conclusion: The FET provides durable midterm performance in different pathologies of the thoracic aorta in terms of avoiding proximal endoleakage/graft failure during follow-up and enabling a robust docking or landing zone for either open surgery or thoracic endovascular repair.

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