Outcomes of Total Arch Replacement and Frozen Elephant Trunk in Acute Aortic Syndrome
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0247
Submission Type:
Abstract Submission
Authors:
Fasolt Meinert (1), Jamila Kremer (1), Mina Farag (1), Anna Meyer (1), Bashar Dib (1), Matthias Karck (1), Rawa Arif (1)
Institutions:
(1) Heidelberg University Hospital, Heidelberg, NA
Submitting Author:
Fasolt Meinert
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Heidelberg University Hospital
Heidelberg University Hospital
Co-Author(s):
Jamila Kremer
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Heidelberg University Hospital
Heidelberg University Hospital
Mina Farag
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Heidelberg University Hospital
Heidelberg University Hospital
Anna Meyer
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Heidelberg University Hospital
Heidelberg University Hospital
Bashar Dib
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Heidelberg University Hospital
Heidelberg University Hospital
Matthias Karck
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Heidelberg University Hospital
Heidelberg University Hospital
Rawa Arif
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Heidelberg University Hospital
Heidelberg University Hospital
Presenting Author:
Rawa Arif
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Abstract:
Objective
Despite increasing reports of successful replacement of the aortic arch for acute aortic syndrome, arch surgery is nonetheless perceived with reverence. Extension of the aortic pathology, preoperative status and GERAADA score should be considered, if total arch replacement is to be decided. Here we present our single centre experience with the frozen elephant trunk (FET) procedure in patients with acute aortic syndrome.
Methods
All patients who underwent frozen elephant trunk (FET) implantation in a setting of acute aortic syndrome between March 2008 and March 2023 were included in this retrospective study. Perioperative data and follow-up data were acquired through patient records and surgery logs.
Results
Overall, 90 patients underwent FET implantation due to acute aortic syndrome, 81 of which were aortic dissections type A (AADA). Mean age was 60.0 (±11.6 sd) years, 74 patients (82%) were male. All had extensive aortic pathologies with involvement of the aortic arch, supraaortic vessels or descending aorta. 27 patients (30%) presented with neurological disorders, including aphasia, hemiparesis, paraparesis and coma. Predicted 30-day mortality by the GERAADA score was 23.9 % (SEM 0.148) on average. All patients were operated in mild to moderate hypothermia with antegrade cerebral perfusion. Several patients underwent concomitant procedures i.e., 32 patients (35%) underwent aortic valve procedure, 8 patients (9%) underwent CABG, 7 patients (8%) underwent TEVAR. In our cohort, we observed a 30-day mortality of 17.4 % (SEM 4.1). Following surgery, neurological disorders were observed in 34 patients (38%). Reexploration for bleeding was required in 13 patients (14%). Postoperative haemodialysis was required in 21 patients (23%). Considering long term outcomes, aortic redo surgery was required in 8 patients (9%) and 5-year survival rate was 78.5%.
Since 2017, favourable results and the introduction of a new type of prosthesis has led to an increased utilization of the approach. 26 patients (29%) received a FET before 2017 and 64 patients (71%) after that time point.
Several preoperative and intraoperative parameters were tested for prediction of 30-day survival. Preoperative lactate levels (p<0.001), preoperative hemiparesis (p=0.035) and preoperative resuscitation (p<0.001) served as significant predictors in a multivariate cox regression. Variables such as procedure time or concomitant procedures had no significant influence on survival.
Conclusions
The recent adaptation of a comprehensive treatment approach i.e., total arch replacement and frozen elephant trunk implantation in acute aortic syndrome led to an improved outcome. Overprediction trend of early mortality by the GERAADA score and a low rate of aortic redo surgery in the long-term course support this idea.
Despite increasing reports of successful replacement of the aortic arch for acute aortic syndrome, arch surgery is nonetheless perceived with reverence. Extension of the aortic pathology, preoperative status and GERAADA score should be considered, if total arch replacement is to be decided. Here we present our single centre experience with the frozen elephant trunk (FET) procedure in patients with acute aortic syndrome.
Methods
All patients who underwent frozen elephant trunk (FET) implantation in a setting of acute aortic syndrome between March 2008 and March 2023 were included in this retrospective study. Perioperative data and follow-up data were acquired through patient records and surgery logs.
Results
Overall, 90 patients underwent FET implantation due to acute aortic syndrome, 81 of which were aortic dissections type A (AADA). Mean age was 60.0 (±11.6 sd) years, 74 patients (82%) were male. All had extensive aortic pathologies with involvement of the aortic arch, supraaortic vessels or descending aorta. 27 patients (30%) presented with neurological disorders, including aphasia, hemiparesis, paraparesis and coma. Predicted 30-day mortality by the GERAADA score was 23.9 % (SEM 0.148) on average. All patients were operated in mild to moderate hypothermia with antegrade cerebral perfusion. Several patients underwent concomitant procedures i.e., 32 patients (35%) underwent aortic valve procedure, 8 patients (9%) underwent CABG, 7 patients (8%) underwent TEVAR. In our cohort, we observed a 30-day mortality of 17.4 % (SEM 4.1). Following surgery, neurological disorders were observed in 34 patients (38%). Reexploration for bleeding was required in 13 patients (14%). Postoperative haemodialysis was required in 21 patients (23%). Considering long term outcomes, aortic redo surgery was required in 8 patients (9%) and 5-year survival rate was 78.5%.
Since 2017, favourable results and the introduction of a new type of prosthesis has led to an increased utilization of the approach. 26 patients (29%) received a FET before 2017 and 64 patients (71%) after that time point.
Several preoperative and intraoperative parameters were tested for prediction of 30-day survival. Preoperative lactate levels (p<0.001), preoperative hemiparesis (p=0.035) and preoperative resuscitation (p<0.001) served as significant predictors in a multivariate cox regression. Variables such as procedure time or concomitant procedures had no significant influence on survival.
Conclusions
The recent adaptation of a comprehensive treatment approach i.e., total arch replacement and frozen elephant trunk implantation in acute aortic syndrome led to an improved outcome. Overprediction trend of early mortality by the GERAADA score and a low rate of aortic redo surgery in the long-term course support this idea.
Aortic Symposium:
Dissection
Image or Table
