Variants of reimplantation of supra-aortic branches of the aortic arch during the 'frozen elephant trunk' procedure.

Abstract

Background: During the last decades, the dynamic development of thoracic aorta surgery has led to implementation of a hybrid technology known as the 'frozen elephant trunk' procedure combining open prosthetic repair of the aortic arch and endovascular intervention on the descending thoracic aorta. This procedure has a series of technical peculiarities, including those related to restoration of the blood flow through the vessels of the aortic arch.

Objective: The study was aimed at assessing the effect of different variants of reimplantation of aortic arch branches on in-hospital outcomes of the 'frozen elephant trunk' procedure.

Patients and methods: Our study included a total of 92 patients who from March 2012 to November 2021 underwent the 'frozen elephant trunk' procedure using hybrid stent grafts. They were subdivided into 3 groups depending on the type of reimplantation of supra-aortic vessels: 'island' technique (34 patients), partial debranching (34 patients), and total debranching (24 patients).

Results: The duration of artificial circulation (p=0.315) and the time cardiac arrest (p=0.586) in the analyzed groups were comparable. Statistically significant differences in the groups were obtained for the duration of the operative intervention (p=0.002). It was observed that in the group of total debranching, the time of surgical intervention was longer. The groups had no differences in the incidence of postoperative stroke, delirium and paraplegia, with a tendency towards an increase in respiratory complications (prolonged artificial pulmonary ventilation, tracheostomy) in the group of patients with total debranching of the supra-aortic vessels as compared with other groups of patients (p=0.065). 30-day mortality amounted to 7.2%.

Conclusion: Making the variant of reconstruction of supra-aortic branches during a hybrid intervention on the aortic arch more difficult was not associated with higher rates of postoperative complications, despite a statistically significant increase in the time of the intervention.