Five-year results of using the «frozen elephant trunk» technique for thoracic aortic dissection

Kozlov B.N.^1,2, Panfilov D.S.¹, Khodashinsky I.A.³

1) Department of Cardiovascular Surgery, Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences,
2) Chair of Hospital Surgery, Siberian State Medical University under the RF Ministry of Public Health,
3) Department of Complex Information Security of Computer Systems, Tomsk State University of Control Systems and Radioelectronics, Tomsk, Russia

Analysed herein is efficacy of hybrid intervention according to the “frozen elephant trunk” procedure in the medium-term period of follow-up in patients operated on for aortic dissection.

During the period from 2012 to 2018, a total of 44 «frozen elephant trunk» procedures were carried out for Stanford type A and B thoracic aortic dissections. All interventions were performed in conditions of moderate hypothermic circulatory arrest (25-28°C) with unilateral cerebral perfusion through the brachiocephalic trunk.

The mean diameter of the implanted stent grafts amounted to 27.7±2.8 mm (range 24-30 mm). The distal edge of the stent graft was located at the level below the Th9 in more than 65% of cases (range Th7-Th12). The stent grafts were fixed proximally at the levels Z0-Z3, predominantly in the Z3 zone (72.7%). Thirty-day mortality amounted to 6.8%, with in-hospital mortality of 15.9%. Five-year survival in acute and chronic type A aortic dissection (AD) amounted to 100 and 80%, respectively (p=0.175). In acute type B aortic dissection five-year survival amounted to 62.2%, being 25.0% for chronic AD (p=0.057). Freedom from reinterventions for acute and chronic type A aortic dissection amounted to 100 and 66.7%, respectively (p=0.286). Freedom from aortic reinterventions for acute and chronic type B aortic dissection amounted to 100% and 75%, respectively (p=0.123).

Reconstructive operations performed according to the «frozen elephant trunk» technique appear to be effective surgical treatment in patients with thoracic aortic dissection, yielding satisfactory clinical results during a medium-term follow-up period.

KEY WORDS: aortic dissension, «frozen elephant trunk», E-Vita open plus, mid-term survival, reintervention.

P. 72-78

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