Preliminary results of debranch-first technique in Frozen Elephant Trunk procedures

Abstract Background To evaluate the outcomes of Frozen Elephant Trunk (FET) procedures performed with a customized graft which allows debranch-first technique with continuous antegrade cerebral perfusion and early distal aortic and myocardial reperfusion. Methods Between 2016 and 2018, 34 patients (30 males; median age 59.7 years) were enrolled in an ambispective single center study called FETOPT (Frozen Elephant Trunk OPTimization - Clinicaltrials.gov: NCT03600077). The patients underwent FET procedure using a novel modified E-vita plus graft with two dedicated reperfusion branches with debranch-first technique. Mortality and morbidity were primary endpoints. Secondary endpoints were overall duration of cardiopulmonary bypass (CPB), debranching, limb ischemia, cardiac ischemia and cerebral perfusion as well as the amount of aortic coverage. Results No deaths at 30 days were recorded, major adverse events (grade > 2 ) rate was 33% (11 patients) including one (3%) non-disabling stroke and one (2.9%) permanent spinal cord ischemic event. Proximal FET collar anastomosis were in zone 0 (68%) or zone 1 (32%). Median CPB duration was 165 minutes (144-185), distal aortic ischemic time and cardiac ischemic time were 38 minutes (32-45) and 74 minutes (62-94) respectively. The time of distal aortic ischemia was shorter in non-obese patients (27 vs 49 min; p=.043 ) and in zone 0 (23 cases) versus zone 1 (11 cases) anastomosis (34 vs 42; p=.043 ). Conclusions FET with debranch-first technique is safe and feasible and resulted in low mortality and morbidity rates. Further investigation is needed to compare it with standard techniques.