Outcomes of total arch replacement and frozen elephant trunk in acute aortic syndrome

Objectives There are several studies from all over the world reporting on frozen elephant trunk implantation and total arch replacement in acute aortic syndrome demonstrating mostly favourable outcomes. Most of these studies present younger study populations carrying a rather low perioperative risk for adverse outcomes. Herein, we present our single centre experience with the frozen elephant trunk procedure in patients with acute aortic syndrome. The patients in this cohort carried a rather high perioperative risk. A considerable number of patients had undergone resuscitation, presented with neurological disorders or presented with malperfusion syndrome. We demonstrate that favourable outcomes are achievable in such high-risk patients using the frozen elephant trunk technique. Methods All patients who underwent frozen elephant trunk implantation in a setting of acute aortic syndrome between March 2008 and March 2023 were included in this retrospective study. Results Overall, 90 patients underwent frozen elephant trunk implantation due to acute aortic syndrome. Mean age was 60.0 (±11.6) years, 74 patients (82%) were male. All had extensive aortic pathologies with involvement of the aortic arch, supraaortic vessels or descending aorta. 27 patients (30%) presented with neurological disorders, including aphasia, hemiparesis, paraparesis and coma. Predicted 30-day mortality by the so called GERAADA score was 23.9% on average. In our cohort, we observed an actual 30-day mortality of 17.4%. Postoperatively, neurological disorders were observed in 34 patients (38%). Aortic redo surgery was required in 8 patients (9%). Several preoperative and intraoperative parameters were tested for prediction of 30-day-survival. Preoperative hemiparesis ( p = 0.012), visceral malperfusion ( p = 0.004) and preoperative resuscitation ( p = 0.003) served as significant predictors in a multivariable cox regression. Conclusions The recent adaptation of frozen elephant trunk implantation in acute aortic syndrome led to an improved outcome. Overprediction trend of early mortality by the GERAADA score and a low rate of aortic redo surgery in the long-term course support this idea.