Concomitant aortic root replacement during frozen elephant trunk implantation does not increase perioperative risk

Abstract

OBJECTIVES: Our aim was to evaluate the risk of concomitant aortic root replacement during frozen elephant trunk (FET) total arch replacement. METHODS: Between March 2013 and February 2021, 303 patients underwent aortic arch replacement using the FET technique. Patient characteristics, intra- and postoperative data were compared between patients with (n = 50) and without (n = 253) concomitant aortic root replacement (implantation of a valved conduit or using the reimplantation valve-sparing technique) after propensity score matching. RESULTS: After propensity score matching, there were no statistically significant differences in preoperative characteristics including the underlying pathology. There was no statistically significant difference regarding arterial inflow-cannulation or concomitant cardiac procedures, while cardiopulmonary bypass (P < 0.001) and aortic cross-clamp (P < 0.001) times were significantly longer in the root replacement group. Postoperative outcome was similar between the groups and there were no proximal reoperations in the root replacement group during follow-up. Root replacement was not predictive for mortality (P = 0.133, odds ratio: 0.291) in our Cox regression model. There was no statistically significant difference in overall survival (log rank: P = 0.062). CONCLUSIONS: Concomitant FET implantation and aortic root replacement prolongs operative times but does not influence postoperative outcomes or increase operative risk in an experienced high-volume centre. The FET procedure did not appear to be a contraindication for concomitant aortic root replacement even in patients with borderline indications for aortic root replacement.