Open distal anastomosis in the frozen elephant trunk technique: Initial experiences and preliminary results of arch zone 2 versus arch zone 3

Abstract

OBJECTIVES: We compared the results of 2 groups of patients who underwent aortic arch replacement with the frozen elephant trunk technique. In the first group, the distal anastomosis was performed in arch zone 2+ADs- in the second control group, the distal anastomosis was performed in arch zone 3. METHODS: Between January 2007 and April 2018, the frozen elephant trunk technique was used in 282 patients. The median age was 62 years (range 18-83 years), and 233 patients were men (82.6+ACU-). Two different frozen elephant trunk prostheses were used: the Jotec E-vita open prosthesis in 167 patients (59.2+ACU-) and the Vascutek Thoraflex hybrid prosthesis in 115 patients (40.8+ACU-). Patients were divided into 2 groups according to the distal anastomosis site: zone 2 group (69 patients) and zone 3 group (213 patients). The main indications were chronic aortic dissection (n +AD0- 164, 58.2+ACU-), degenerative aneurysm (n +AD0- 72, 25.5+ACU-) and acute aortic dissections (n +AD0- 45, 16+ACU-). RESULTS: The overall in-hospital mortality rate was 17+ACU-: 20+ACU- for the zone 2 group and 16+ACU- for the zone 3 group, without significant differences, also in terms of cardiopulmonary bypass and myocardial ischaemia times. However, the visceral ischaemia time was significantly shorter for the zone 2 group, whereas the antegrade selective cerebral perfusion time was significantly longer for the same group. Recurrent laryngeal nerve injury rate was lower in the zone 2 group. The overall postoperative paraplegia rate was 3.5+ACU-, whereas the occurrence of permanent neurological dysfunction and dialysis was 9+ACU- and 19+ACU-, respectively, with no significant differences between the groups. CONCLUSIONS: 'Proximalization' of the distal anastomosis can be used for arch reconstruction, especially in complex cases such as reoperations or acute aortic dissections. Furthermore, with the aid of branched hybrid grafts, a reduction of the visceral ischaemia time is achieved. +ACY-copy+ADs- 2019 The Author(s) . Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.