Experience with the conventional and frozen elephant trunk techniques: a single-centre study

OBJECTIVES: The treatment of patients with extensive thoracic aortic disease involving the arch and descending/thoracoabdominal aorta is often performed using an elephant trunk procedure. We retrospectively analysed our results comparing two different techniques: the conventional elephant trunk (cET) and the frozen elephant trunk (FET) operation. METHODS: Between January 2003 and December 2011, 171 consecutive patients underwent total aortic arch replacement with either a cET (n= 125) or FET (n= 46) technique. The mean age was 64 ± 13 years and was significantly higher in the FET group (P 40 min was an independent predictor for permanent spinal cord injury (OR 5.0, 95% CI 1.1–20, P= 0.038). The estimated 1-, 3- and 5-year survival were 70 ± 4, 70 ± 4 and 68 ± 4% (cET) and 4 ± 7 and 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 procedure for extensive thoracic aortic disease is associated with an acceptable mortality rate, but with a higher incidence of perioperative spinal cord injury than cET. Arch replacement with a cET technique should be strongly considered in patients with expected prolonged circulatory arrest times, particularly if operated on under mild or moderate hypothermia. Axillary cannulation is associated with superior neurological outcomes and Type A acute aortic dissection is a risk factor for mortality and poor neurological outcomes in this patient population.