title: Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: results of a multicentre study.
abstract: OBJECTIVE
  The treatment of patients with extensive thoracic aortic disease involving the arch and descending aorta is often performed, using the frozen elephant trunk (FET) technique. We retrospectively analysed early outcomes with this technique, using a prospective database.
  
  
  METHODS
  A total of 509 patients (mean age: 61 ± 11 years) were registered between January 2005 and January 2014 in a multicentre database after FET surgery. Acute or chronic aortic dissection (AD) was the indication for surgery in 350 (68.8%) patients and degenerative or atherosclerotic aneurysm (DA) accounted for 159 (31.2%) patients. A logistic regression model was created to identify independent predictors of in-hospital mortality and neurological complications.
  
  
  RESULTS
  The average in-hospital mortality was 15.9% (n = 81) with 17.1% for AD patients and 13.2% for DA patients (P = 0.2). Independent predictors of in-hospital mortality were haemodynamic instability [odds ratio (OR): 2.7, P = 0.005], peripheral vascular disease (OR: 2.6, P = 0.002), diabetes (OR: 2.1, P = 0.05) and selective cerebral perfusion time >60 min (OR: 2.2, P = 0.005). Patients under 60 years of age and the use of guide wire during FET implantation were protective for early survival. Stroke occurred in 7.7% (n = 39) of patients. Paraplegia or paraparesis occurred in 7.5% (n = 38) of patients. A distal landing zone lower than T10 was an independent predictor for spinal cord injury (OR: 2.3, P = 0.03).
  
  
  CONCLUSIONS
  Techniques for faster arch replacement and controlled FET placement should be considered in order to reduce the early mortality and neurological complications after FET surgery. For distal aortic lesions, a two-staged approach is suggested, rather than the FET landing lower than T10.
authors.affiliation: Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany sergey.leontyev@medizin.uni-leipzig.de.
authors.forename: Sergey
authors.initials: S
authors.lastname: Leontyev
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Centre Essen, University Hospital Essen, Essen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.affiliation: Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Weiss
authors.affiliation: Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwoeger
authors.affiliation: Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Jorge G
authors.initials: JG
authors.lastname: Mascaro
authors.affiliation: Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Mauro
authors.initials: M
authors.lastname: Iafrancesco
authors.affiliation: Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Ulrich F
authors.initials: UF
authors.lastname: Franke
authors.affiliation: Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Nora
authors.initials: N
authors.lastname: Göbel
authors.affiliation: Tampere University Hospital Heart Center, Tampere, Finland.
authors.forename: Thanos
authors.initials: T
authors.lastname: Sioris
authors.affiliation: Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland.
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Widenka
authors.affiliation: Department of Cardio Vascular Surgery, Hospital Clinico, University of Barcelona, Barcelona, Spain.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Mestres
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Centre Essen, University Hospital Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002908:Chronic Disease; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Aortic arch surgery; Frozen elephant trunk; Risk factors