Long-Term Results with 187 Frozen Elephant Trunk Procedures

J. Clin. Med., 2023 · DOI: 10.3390/jcm12124143 · Published: June 20, 2023

Simple Explanation

The frozen elephant trunk (FET) technique is a surgical procedure used to treat complex aortic diseases. This study reports the long-term clinical outcomes of 187 patients who underwent FET repair between August 2005 and March 2023. The study found that while the FET procedure has acceptable operative mortality, spinal cord injury, and stroke rates, long-term survival is affected by the need for secondary interventions due to pre-existing aortic pathology and late aortic growth.

Study Duration

17 years 1 Month

Participants

187 consecutive patients

Evidence Level

Not specified

Key Findings

1
Overall survival rates at five and ten years post-FET procedure were 69.9% and 53.0%, respectively.
2
Freedom from aortic-related death at five and ten years was 82.5% and 75.8%, respectively.
3
The rate of freedom from secondary interventions at ten years was 44.7% overall, with variations based on the initial pathology (acute dissections, chronic dissections, and aneurysms).

Research Summary

This study examined long-term outcomes of the frozen elephant trunk (FET) procedure in 187 patients, revealing acceptable operative mortality but a high reintervention rate due to pre-existing aortic issues. Long-term survival rates show a decline over time, with overall survival at five years being 69.9% and at ten years 53.0%, indicating the need for careful follow-up. The study emphasizes the importance of annual follow-up due to late aortic growth in untreated segments, which can lead to fatal outcomes even after ten years post-procedure.

Practical Implications

Mandatory Annual Follow-Up

Due to the risk of late aortic growth and potential fatal outcomes, lifelong annual follow-up is essential for patients undergoing FET procedures.

Tailored Treatment Strategies

Treatment strategies should be individually tailored, especially in elective cases, to address as much aortic pathology as possible and prevent emergent reoperations.

Optimal Landing Zone

The FET stent graft offers an optimal landing zone for secondary interventions, even in genetic aortic syndromes, making it a valuable tool in multi-stage treatment strategies.

Study Limitations

1
Retrospective observational character
2
Relatively small number of patients, especially in the chronic dissection subgroup
3
Single center design

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