Aortic Reinterventions after the Frozen Elephant Trunk Procedure for Aortic Dissection

Objectives: The aim of this study was to evaluate the need and outcomes of aortic reinterventions after previous frozen elephant trunk (FET) repair for acute and chronic thoracic aortic dissections.

Methods: Between March 2013 and April 2018, 76 patients underwent the FET procedure for acute (33 patients, 43%) or chronic (43 patients, 57%) thoracic aortic dissections. Patient characteristics and follow-up data were evaluated and compared between patients with aortic reinterventions and without aortic reinterventions. A competing risk regression model was analyzed to identify independent predictors of aortic reintervention and to predict the risk for reintervention.

Results: Five patients (7%) expired following the initial FET implantation. Intended completion, anticipated, and unexpected reinterventions were performed in 26 of the surviving patients (37%). There was no difference in the type of aortic dissection or in the acuteness of the aortic dissection between patients with or without aortic reintervention. An endovascular reintervention was performed in 17 patients (65%), open surgery in 6 patients (23%), and a hybrid approach in 3 patients (12%). No stroke or permanent spinal cord injuries were observed after the reintervention. In-hospital mortality after reintervention was 12% (3 patients), but there was no difference in the survival during follow-up after FET implantation (log rank: 0.98) between patients with and without aortic reintervention. Marfan’s syndrome (95% confidence interval [CI]: 1.06–9.16, p = 0.039) was the only risk factor identified for aortic reinterventions in the competing risk analysis. The risk for aortic reintervention was 16% (95% CI: 8–26), 38% (95% CI: 24–52), and 63% (95% CI: 43–77) after 12, 24, and 36 months, respectively.

Conclusion: Aortic reinterventions are common and likely after FET implantation, but this study identified Marfan’s syndrome as the only independent predictor. Reinterventions are associated with low perioperative morbidity and mortality. Close follow-up of all FET patients is paramount.