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OBJECTIVE:
The frozen elephant trunk (FET) technique is a one-stage hybrid approach involving antegrade stent graft implantation for descending aortic pathology, and open repair of the aortic arch and ascending aorta. The objective of this study was to review our experience with the JOTEC E®-vita Hybrid prosthesis, evaluating the comparative efficacy of the treatment for aortic dissection and aneurysmal disease.
METHODS:
The Heart Center database was examined to identify patients who underwent a FET procedure using the JOTEC E®-vita Hybrid prosthesis. Patients were divided into 2 groups, depending on whether the indication for treatment was aortic dissection (Group 1) or aneurysmal disease (Group 2). A retrospective chart review was performed to collect data on indications, techniques, and outcomes.
RESULTS:
From 01/2006 to 09/2011, 36 patients (53% male) with a mean age of 67+/-14 yrs, were treated with the FET technique. The indication was aortic dissection in 13/36 patients (36%, Group 1), and aneurysm in 23/36 (64%, Group 2). Secondary endovascular intervention was more frequently required for group 1 patients than group 2 patients (2/13, 15% vs. 2/23, 9%, p=0.19), as was secondary surgical intervention (2/13, 15% vs. 1/23, 4%, p=0.003). Hospital mortality was 4/36 (11%), and lower in Group 1 patients than Group 2 patients (1/13, 8% vs. 3/23, 13%, p=0.38), with 4 additional deaths during mid-term follow-up.
CONCLUSIONS: One-stage treatment of extensive aortic disease is feasible, and associated with a mortality comparable to that observed in 2-stage series. When performed for aortic dissection, the frozen elephant trunk technique results in higher secondary intervention rates than for aneurysm. However, continued aortic surveillance is required for all patients, and further research should be directed towards eliminating the need for reintervention.