FET as a Redo after Proximal Repair: Two-Center Experience

P0138 

Abstract Submission 

Florian Huber (1), Zsuzsanna Arnold (2), Bruno Schachner (1), Jessica Gottsberger (3), Armin Kai Schöberl (1), Sandra Folkmann (4), Daniela Geisler (4), Gabriel Weiss (4), Martin Grabenwoger (2), Andreas Zierer (1)

(1) Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, JKU, Linz, Austria, (2) Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Vienna, (3) Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, JKU, Linz, Linz, (4) Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria

Florian Huber    -  Contact Me
Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, JKU

Zsuzsanna Arnold    -  Contact Me
Department of Cardiovascular Surgery, Clinic Floridsdorf

Bruno Schachner    -  Contact Me
Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, JKU

Jessica Gottsberger    -  Contact Me
Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, JKU

Armin Kai Schöberl    -  Contact Me
Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, JKU

Sandra Folkmann    -  Contact Me
Department of Cardiovascular Surgery, Clinic Floridsdorf

Daniela Geisler    -  Contact Me
Department of Cardiovascular Surgery, Clinic Floridsdorf

Gabriel Weiss    -  Contact Me
Department of Cardiovascular Surgery, Clinic Floridsdorf

Martin Grabenwoger    -  Contact Me
Department of Cardiovascular Surgery, Clinic Floridsdorf

Andreas Zierer    -  Contact Me
Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, JKU

Florian Huber    -  Contact Me
N/A

Objective:
In many cases of acute aortic dissection, the dissection extends beyond the left subclavian artery. Initial aortic repair leaves the downstream aorta untouched. The residually dissected aorta carries the risk of aneurysm formation requiring secondary intervention. The aim of this study was to evaluate the outcome of patients undergoing aortic arch replacement employing the frozen elephant trunk (FET) technique after surgery for acute dissection.
Methods:
Sixty-six consecutive patients (60% men, mean age: 57±12 years, ES II: 7.29±5.21) underwent open redo aortic arch replacement at two Austrian centers. The reoperation was performed through a repeat sternotomy using selective antegrade cerebral perfusion (bilateral n=48, 72.7%, unilateral n=18, 27.3%) under moderate- to- mild hypothermic circulatory arrest (28°C bladder temperature) in all patients. Intraoperative details, clinical outcomes and follow-up data were evaluated.
Results:
Redo FET was performed using either a conventional technique with the distal anastomosis in Ishimaru zone 3 (n=25, 37.9%) or a simplified technique with an anastomosis in zone 2 (n=41, 62.1%). Cardiopulmonary bypass time totaled 208±50 min and myocardial ischemic time was 102±33 min. Mean duration of selective antegrade cerebral perfusion (ACP) was 57±19 min. In-hospital mortality was 3% (n=2). Postoperative neurological complications comprised stroke (n=6, 9.1%) and spinal cord injury (temporary n=1, 1.5%; permanent n=2, 3%). Postoperative renal failure occurred in 10 patients (15%), necessitating temporary or permanent dialysis in 9 (13.6%) and 1 (1.5%) patients, respectively. Median intensive care unit stay was 3 days. Survival rates after 1, 3 and 5 years were 95%, 88% and 85%, respectively. A multivariate analysis, using a Cox regression model, identified older age, new dialysis and stroke as predictors of mortality (HR = 1.0909, 95% CI, 1.05 – 1.12, HR = 2.37, 95% CI, 1.53 - . 3.65, HR = 1.58, 95% CI, 1.15 – 2.16, respectively).
Conclusions:
Our data suggest that redo FET following previous aortic surgery for acute aortic dissection performed by a dedicated aortic team shows an excellent safety profile. Survival rates are very promising despite the high-risk nature of the surgery. Nonetheless, stroke and renal failure are concerns that can influence late outcome. Furthermore, successful redo aortic arch surgery employing the FET technique serves as an ideal platform for distal aortic interventions.

Aortic Arch