Frozen elephant trunk with straight vascular prosthesis: single-center experience with a review of current trends

BACKGROUND: We aim to reflect on our experience utilizing the frozen elephant trunk (FET) and straight vascular prostheses. METHODS: Three hundred patients from 2005 to 2018 were identified from our prospectively collected data stratifying the patients who underwent aortic surgery including the arch and distal aortic stream. We examined the pre-operative and operative characteristics of these patients along with in-hospital outcomes and follow-up survival. Continuous and categorical variables were analyzed using two-sided unpaired 1-test and Fischer's Exact test, respectively. Kaplan Meter analysis was used to evaluate survival. RESULTS: Three hundred patients (mean age 59) underwent one stage surgery utilizing our FET for acute type A aortic dissection (ATAAD, 55%), chronic aortic dissection (CAD, 23%) and thoracic aortic aneurysm (TAA. 22%). 30-day mortality was 12%, highest amongst the ATAAD group (12.8%). Neurological deficit stratified into permanent stoke and paraplegia was 7% and 2% respectively. Freedom from aortic related death at 10 years was 91%. Survival probability at 5 years for ATAAD, CAD & TAA was 91%, 98% and 92% respectively. Freedom from re-intervention in ATAAD proximal repair vs. FET was 68% vs. 87% at 5 years and 48% vs. 74% at 10 years respectively. Patients were separated according to distal anastomosis level in zone 2 (Z2, 237) and zone 3 (Z3, 105). Conceptual zone 2 versus zone 3 aortic arch replacement survival analysis at 5 years was Z2 - 75% vs Z3 - 60% (P-0.034); and at 8 years was Z2 - 74% vs. Z3 - 52% (P=0.018). CONCLUSIONS: Frozen elephant trunk using EVITA Hybrid Open Plus stent graft and other devices in the family of device technology attain optimal outcomes to treat complex thoracic aortic lesions in elective and non-elective settings.