117 * LONG-TERM RESULTS OF THE FROZEN ELEPHANT TRUNK TECHNIQUE FOR ACUTE TYPE A AORTIC DISSECTION FROM A 15-YEAR EXPERIENCE

Abstract

Objectives: The aim of this study is to evaluate prophylactic repair of the descending aorta using the frozen elephant trunk (FET) technique for acute type A aortic dissection (AAAD) considering the long-term prognosis. Methods: Between 1997 and 2012, 120 consecutive patients (mean age 64.4 years) underwent total arch replacement with the FET technique for AAAD. There were 34 patients with an entry on the descending aorta, 68 patients with an age younger than 70 years, and eight patients with Marfan syndrome. Preoperative morbidities consisted of 23 patients with stroke, 10 patients with coronary ischaemia, and nine patients with visceral ischaemia. A stent graft, the diameter of which was determined by intraoperative measurement, was inserted under transoesophageal echographic guidance. Results: Five patients died in hospital. Early morbidity included four strokes and one spinal cord injury. Computed tomography before discharge demonstrated complete thrombosis of the true lumen on a stent graft in 115 patients with a mean 26.0 mm lumen diameter compared with a mean 27.8 mm diameter of the stent graft. In the long-term follow-up (mean 104.6 months), 13 patients died of non-aortic events; five distal aortic reoperations using endovascular stent grafting to the descending aorta, including one case with new tear formation, were required. No patients had a patent false lumen on the stent graft according to last follow-up computed tomography. The 10-year survival was 75% and the overall 10-year reoperation-free rate on the thoracic aorta was 93%. Conclusions: The FET technique resulted in excellent aortic remodelling on the downstream aorta and could improve the long-term outcome for AAAD