title: The frozen elephant trunk technique for the treatment of complicated type B aortic dissection with involvement of the aortic arch: multicentre early experience.
abstract: OBJECTIVE
  Providing effective treatment for complicated type B aortic dissection (AD) with concomitant pathologies of the aortic arch or ascending aorta is challenging, especially if the aortic anatomy is contraindicated for thoracic endovascular aortic repair (TEVAR). We present the early results of a multicentre study using the frozen elephant trunk (FET) technique for type B AD.
  
  
  METHODS
  From January 2005 to March 2013, data from 465 patients who had undergone treatment with the FET technique were collected in the database of the International E-vita Open Registry. From this cohort, 57 patients who had a primary indication for surgery for type B AD were included in the present study. Their mean age was 58±12 years, and 72% had a chronic dissection. All operations were performed in circulatory arrest and bilateral antegrade cerebral perfusion. Computed aortic imaging was performed for false lumen (FL) evaluation during the follow-up.
  
  
  RESULTS
  The in-hospital mortality rate was 14% (8/57). Stroke and spinal cord injury occurred in 6 (10%) and 2 patients (4%), respectively. The rate of immediate FL thrombosis at the level of the stent graft was 75% (40/53) and increased to 97% (41/42) during the follow-up period (23±19 months). Distally, at the level of the abdominal aorta, the FL remained patent in 50% (21/42) of patients. The 1- and 3-year survival was 81 and 75%, respectively.
  
  
  CONCLUSIONS
  The FET technique is a feasible therapeutic option for complicated type B AD with involvement of the aortic arch if TEVAR is contraindicated. In contrast to conventional aortic surgery via a lateral thoracotomy, the FET procedure can provide simultaneous treatment of the ascending aorta and aortic arch.
authors.affiliation: Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria gabrielweiss@me.com.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Weiss
authors.affiliation: Department of Cardiac Surgery, University Hospital Essen, Essen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.affiliation: Department of Cardiac Surgery, University Hospital Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: Department of Cardiovascular Surgery, University Bologna, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.affiliation: Department of Cardiovascular Surgery, University Bologna, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: Department of Cardiovascular Surgery, University Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Barberio
authors.affiliation: Department of Cardiac Surgery, University Birmingham, Birmingham, UK.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mascaro
authors.affiliation: Hospital Clinico, University Barcelona, Barcelona, Spain.
authors.forename: Carlos-A
authors.initials: CA
authors.lastname: Mestres
authors.affiliation: Department of Cardiac Surgery, University Tampere, Tampere, Finland.
authors.forename: Thanos
authors.initials: T
authors.lastname: Sioris
authors.affiliation: Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwoger
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged
keywords: Aorta; Aortic syndromes; Frozen elephant trunk technique; International E-vita Open Registry; Type B aortic dissection