Perioperative and long-term outcome after ascending aortic and arch repair with elephant trunk and open thoracoabdominal aortic aneurysm repair.

Abstract Objective Describe outcome of open thoracoabdominal aortic aneurysm (TAAA) repair following previous aortic arch repair including elephant trunk (ET) or frozen elephant trunk (FET) for acute and chronic pathologies. Methods Retrospective observational multicenter study including 32 patients treated between 2006 and 2019 in two aortic centers using identical surgical protocols. Assessment focused on peri-operative and long-term outcome, namely in-hospital morbidity and mortality as well as procedure-related re-intervention rate and aortic-related mortality rate. Kaplan-Meier curves with 95%-confidence intervals were used to analyse the overall survival after surgery within the cohort. Results 32 patients (mean age was 45.0 ± 13.6, 20 males [62.5%]) were treated because of acute (34.38 % [n = 11]) or chronic (65.62 % [n = 21]) aortic pathologies including residual dissection following acute, symptomatic type A dissection (n = 7), symptomatic mega aortic syndrome (MAS) (n = 4) as well as post-dissection TAAA (n = 18) and asymptomatic MAS (n = 3). 28 patients (87.5 %) received type II repair and 4 patients (12.5%) received type III repair after previous ascending aorta and arch repair including ET/FET. Concomitant infrarenal and iliac vessel repair was performed in 38.7 % (n = 12), respectively 29.4 % (n = 10). In-hospital mortality rate was 18.75 % (n = 6). Spinal cord ischemia occurred in two cases, both after one-stage emergency procedure with one case of permanent paraplegia. Temporary acute kidney injury occurred in 41.94 % (n = 13). The estimated 1-year survival rate was 78.1% (95%-CI = [63.9%, 95.6%]) with a median follow-up time of 1.29 years (IQR: 0.26 – 3.88). No procedure-related re-interventions and one case of aortic-related mortality, namely sepsis because of graft infection, was observed. Conclusion Open TAAA repair following aortic arch repair including ET or FET because of acute or chronic aortic pathologies is associated with a relevant peri-operative morbidity and mortality rate. During follow up a low aortic-related mortality rate and procedure-related re-intervention rate were observed.