Extended thoracic aorta pathology: hybrid treatment with the frozen elephant trunk technique

Background. Aneurysms of the aortic arch extending beyond the origin of the left subclavian artery represent a challenging pathology in aortic surgery and, most commonly, are treated with different surgical, endovascular or hybrid two-staged procedures. In 2006, we initiated an intense surgical program with the frozen elephant trunk procedure that, combining together conventional surgery with endovascular techniques, allows single-stage treatment of patients with extended disease of the thoracic aorta. We here describe our surgical technique and the results with the single-stage frozen elephant trunk procedure. Methods. Between January 2007 and August 2010, 87 patients were treated with the frozen elephant trunk procedure in our institution. The mean age was 62 +/- 10 years. Indications for surgery included: chronic aneurysm (n=28; 32.2%), acute type A dissection (n=5; 5.7%), acute type B dissection (n=2; 2.3%), chronic type A dissection (n=41; 47.2%), chronic type B dissection (n=11; 12.6%). Forty-nine patients (56.4%) had undergone previous cardiac/aortic operations. Sixty-four associated aortic/cardiac operations were performed. Results. Hospital mortality was 12.6%. Postoperatively, major neurological complications occurred in 4 patients (4.5%) and paraplegia in 6 (6.9%). Follow-up was 100% completed at a mean time of 15.0 +/- 12.4 months. Estimated 3-year survival was 72.7 +/- 8.3%. Endovascular extension was required in 14 patients (16.0%) with a technical/procedural success of 100%. Conclusions. Our preliminary results with the frozen elephant trunk in the above-mentioned high-risk group of patients were encouraging. The frozen elephant trunk, as a single-stage hybrid procedure, avoids peculiar drawbacks of staged procedures such as cumulative mortality of two major aortic procedures, interval mortality and failure to complete the final stage.