The Comparison between Frozen Elephant Trunk Technique and Conventional Total Arch Replacement, a Single-center Study

Amarit  Phothikun; Dit  Yoongtong; Weerachai  Nawarawong; Surin  Woragidpoonpol

doi:10.33192/Smj.2022.92

Authors

Amarit Phothikun Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine / Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine / Clinical Surgical Research Center, Chiang Mai University, Chiang Mai
Dit Yoongtong Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai
Weerachai Nawarawong Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine / Clinical Surgical Research Center, Chiang Mai University, Chiang Mai
Surin Woragidpoonpol Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine / Clinical Surgical Research Center, Chiang Mai University, Chiang Mai

DOI:

https://doi.org/10.33192/Smj.2022.92

Keywords:

Aortic arch, Frozen elephant trunk technique, Conventional total arch replacement

Abstract

Objective: The advantage of the frozen elephant trunk technique (FET) is treating the aortic pathology extending from the aortic arch to the descending aorta in a one-stage operation. This study aimed to determine the early and long-term outcomes of total arch replacement with the frozen elephant trunk technique compared to conventional total arch replacement (cTAR).

Materials and Methods: This study was a single-center, retrospective cohort study. Patients who underwent aortic arch replacement between January 2009 and December 2020 were enrolled and divided into two groups. 32 patients underwent the FET and 47 patients underwent cTAR. Outcomes and survival analysis were compared.

Results: The 5-year survival for FET and cTAR were 87.27% and 82.55% and the aortic-related mortality was not significantly different (HR 0.97, 95%CI 0.22-0.43). Aortic re-intervention was significantly lower in the FET group accounting for 3.57%, while there was 39.1% in the cTAR group. FET significantly reduced aortic re-intervention compared with cTAR (HR 0.09, 95%CI 0.01-0.81). There were no differences in the incidence of stroke between the two groups. However, FET patients had significantly increased risks of paraplegia by 21% when compared to cTAR (Risk difference +0.21, 95%CI 0.02-0.40)

Conclusions: The FET technique had comparable early outcomes in terms of mortality, renal function, postoperative bleeding, and recurrent laryngeal nerve injury. Even though FET had a significant risk of postoperative paraplegia, FET reduced the aortic re-intervention rate without increasing aortic-related death.

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