Neurological outcome after conventional elephant trunk and frozen elephant trunk technique in treatment of patients with thoracic aortic disease

Objective: The elephant trunk procedure is the standard method for treatment patients with extensive thoracic aortic disease. We retrospectively analyzed our results comparing conventional elephant trunk (cET) and frozen elephant trunk (FET) techniques. Methods: One hundred seventy one patients underwent total aortic arch replacement with a cET (n = 125) or FET (n = 46) technique between 2003 and 2011. Mean age was 64 ± 13 years and 39.8% were male. The degenerative or atherosclerotic aneurysm accounted for 33.6% of cET and 58.7% of FET, acute type A aortic dissection was the indication for surgery in 54.4% of cET and 21.6% of FET patients. Results: The overall 30 day mortality was 16.4%; 19.2% vs. 8.7% for cET and FET patients, respectively (p = 0.1). Stroke occurred in 16% versus 10.9% (cET vs. FET, p = 0.4). Type A aortic dissection was identified as an independent predictor of 30 day mortality (OR 3.1, p = 0.01) and stroke (OR 2.6, p = 0.03). Axillary arterial canulation (OR 0.4, p = 0.03) was protective against stroke. The occurrence of new paraplegia was significantly higher in the FET group (21.7% vs. 4.0%, p < 0.001), and FET (OR 6.6, p = 0.001) was an independent predictor for paraplegia. The estimate 1, 3 and 5 years survival was 70 ± 4%, 70 ± 4%, 68 ± 4% (cEF) and 74 ± 7%, 60 ± 9%, 40 ± 1% (FET) with mean survival time 5.2 ± 0.3 vs. 3.8 ± 0.5 years (cET vs. FET, log rank p = 0.9). Conclusions: The FET technique can be used for treatment of patients with extensive thoracic aortic disease with an acceptable mortality rate. This technique associated with a higher incidence of perioperative spinal chord injury. Axillary arterial canulation is protective against stroke and type A acute aortic dissection is a risk factor for mortality and poor neurological outcomes in such patients.