AUTHOR=Göbel Nora , Holder Simone , Hüther Franziska , Anguelov Yasemin , Bail Dorothee , Franke Ulrich 

TITLE=Frozen elephant trunk versus conventional proximal repair of acute aortic dissection type I

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1326124

DOI=10.3389/fcvm.2024.1326124

ISSN=2297-055X

ABSTRACT=<sec><title>Objective</title><p>The extent of surgery and the role of the frozen elephant trunk (FET) for surgical repair of acute aortic dissection type I are still subjects of debate. The aim of the study is to evaluate the short- and long-term results of acute surgical repair of aortic dissection type I using the FET compared to standard proximal aortic repair.</p></sec><sec><title>Methods</title><p>Between October 2009 and December 2016, 172 patients underwent emergent surgery for acute type I aortic dissection at our center. Of these, <italic>n</italic> = 72 received a FET procedure, while the other 100 patients received a conventional proximal aortic repair. Results were compared between the two surgery groups. The primary endpoints included 30-day rates of mortality and neurologic deficit and follow-up rates of mortality and aortic-related reintervention.</p></sec><sec><title>Results</title><p>Demographic data were comparable between the groups, except for a higher proportion of men in the FET group (76.4% vs. 60.0%, <italic>p</italic> = 0.03). The median age was 62 years [IQR (20), <italic>p</italic> = 0.17], and the median log EuroSCORE was 38.6% [IQR (31.4), <italic>p</italic> = 0.21]. The mean follow-up time was 68.3 ± 33.8 months. Neither early (FET group 15.3% vs. proximal group 23.0%, <italic>p</italic> = 0.25) nor late (FET group 26.2% vs. proximal group 23.0%, <italic>p</italic> = 0.69) mortality showed significant differences between the groups. There were fewer strokes in the FET patients (FET group 2.8% vs. proximal group 11.0%, <italic>p</italic> = 0.04), and the rates of spinal cord injury were similar between the groups (FET group 4.2% vs. proximal group 2.0%, <italic>p</italic> = 0.41). Aortic-related reintervention rates did not differ between the groups (FET group 12.1% vs. proximal group 9.8%, <italic>p</italic> = 0.77).</p></sec><sec><title>Conclusion</title><p>Emergent FET repair for acute aortic dissection type I is safe and feasible when performed by experienced surgeons. The benefits of the FET procedure in the long term remain unclear. Prolonged follow-up data are needed.</p></sec>