Intermediate outcomes following arch reconstruction with frozen elephant trunk, a single centre study

Journal of Cardiothoracic Surgery, 2023 · DOI: https://doi.org/10.1186/s13019-023-02140-5 · Published: January 5, 2023

Simple Explanation

Surgery on the aortic arch and proximal descending thoracic aorta can be lifesaving but is also associated with significant morbidity, ranging from minor infections to severe neurological impairments as well as a substantial risk of mortality. This study clinically assesses outcomes, with special regards to neurologic injury, as well as seeks to identify predictors of in-hospital mortality in two patient groups with different underlying aortic pathology, aneurysms and dissections, undergoing arch/descending aortic repair. The study found that postoperative dialysis was a predictor of in-hospital mortality, while both dialysis as well as reoperation due to bleeding and/or visceral ischemia increased the risk for overall mortality, irrespective of preoperative diagnosis.

Study Duration

106 Months

Participants

34 patients (17 aneurysms, 17 dissections)

Evidence Level

Not specified

Key Findings

1
In-hospital mortality was 18%.
2
67% suffered any form of neurological affection, when also cognitive afflictions were included.
3
Previous or current smoking appeared to be associated with negative outcomes regarding both in-hospital and overall mortality during follow-up.

Research Summary

This study evaluates mid-term outcomes following FET surgery for either dissection or aneurysm, performed at a single centre, Uppsala University Hospital. The incidence of in-hospital mortality is comparable but in the higher interval of the commonly reported levels (7.7–15.9%) (9–11), but the levels of neurological injury (stroke and SCI) are similar to previously reported results [4, 6–9, 11, 12]. Minor complications with the potential for worsening occur in practically all patients operated for complex aortic disease. Survival through the immediate perioperative phase confers a good mid-term survival, albeit with the need for reinterventions and more so in the dissection group.

Practical Implications

Perioperative Renal Protection

Enhanced perioperative renal protection and perfusion strategies could help decrease mortality after FET surgery.

Visceral Perfusion Awareness

Meticulous attention to visceral perfusion could reduce renal injuries and mortality rates.

Optimized Coagulation Management

Stringent attention to optimizing coagulation could decrease re-exploration for bleeding.

Study Limitations

1
Limited size of the analyzed cohort
2
Further studies with increased sample sizes would be a valuable means of possibly finding statistically significant prediction factors for surgical outcome.
3
Definitions of both SCI and neurologic injury have previously not been subject to standardized classification, providing less reliability to reported results

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