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Total Arch Replacement using Frozen Elephant Trunk Technique for Residual Dissection after Acute Type-A Dissection Repair
Makoto Hibino1, Akihiko Usui2, Hideki Oshima2, Masato Mutsuga2, Yoshiyuki Tokuda2, Hideki Ito2.
1Tokyo Bay Urayasu Ichikawa Medical Center, Tokyo, Japan; 2Nagoya University Graduate School of Medicine, Cardiac Surgery, Nagoya, Japan.
OBJECTIVE: The purpose of this study is to assess the result of total arch replacement using manufactured frozen elephant trunk (FET) for chronic aortic dissection after initial repair including the effect of aortic remodeling by the FET.
METHODS: Between 2003 and 2015, in our institution, we performed 62 operations for chronic aortic dissection after initial acute type-A dissection repair. Total arch replacement (TAR) was performed for 32 patients by using manufactured FET in 11, handmade FET in 6, and elephant trunk in 12. The patients treated by manufactured FET were reviewed in this study. Average age was 66.2±8.0 years. Initial repairs before 6.6±4.1 years were 9 ascending aortic replacements and 2 Bentall operations. The entry of residual dissection was located at arch in 7 and at distal anastomosis site in 4. The length of manufactured FET was 6cm in 2, 9cm in 3 and 12 cm in 6, and average length of inserted elephant trunk was 14.1±2.1cm. CT was performed 2.1±1.9 months after operation. Descending aorta was assessed at each level of tracheal bifurcation, pulmonary bifurcation (P), aortic valve (A) and diaphragm (D).
RESULTS: Postoperative ICU stay was 8.4±9.7 days and hospital stay was 37.7±20.9 days. There was no hospital death. The operative complication included 2 surgical site infection, 1 interstitial pneumonia and 1 paraplegia, which was recovered except for sensory impairment. Postoperative CT at intervals of 2.1±1.9 months showed no entry at new distal anastomosis site, thrombosed false lumen above P in 2, above A in 1 and above D in 7. Distal end of the FET located at A in 7 and at P in 4. Though significant aortic remodeling (increased diameter of true lumen and decreased diameter of false lumen) was achieved, the total diameter of aorta was increased at each level.
CONCLUSIONS: TAR using manufactured FET after acute type-A dissection repair promoted entry closure and thrombosis of false lumen. It requires long-term observation to judge the effect for aortic remodeling. 
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