• Akira Katayama, Naomichi Uchida, Keijiro Katayama, Miwa Arakawa, and Taijiro Sueda.
• Division of Cardiovascular Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan katayama@asa-hosp.city.hiroshima.jp.
• Eur J Cardiothorac Surg. 2015 Feb 1;47(2):355-60; discussion 360.

ObjectivesWe aimed to evaluate the long-term prognosis of prophylactic repair of the descending aorta using the frozen elephant trunk (FET) technique for acute type A aortic dissection (AAAD).MethodsBetween 1997 and 2012, 120 consecutive patients (mean age: 64.4 ± 10.9 years) underwent total arch replacement with FET for AAAD; 36 patients had an entry at the descending aorta, 68 patients were aged <70 years and 8 patients had Marfan's syndrome. With regard to preoperative morbidity, 23 patients had stroke, 10 had coronary ischaemia and 9 had visceral ischaemia. During intraoperative measurement, the required size and length of the stent graft were determined and inserted under transoesophageal echographic guidance.ResultsSeven patients (6%) died in the hospital. Four (3%) cases of stroke and 2 (2%) with spinal cord injuries were noted. Computed tomography prior to discharge indicated complete thrombosis of the false lumen by the stent graft in 113 patients, with a mean diameter of 26.0 ± 2.5 mm before discharge and 27.5 ± 2.5 mm at 1 year postoperatively compared with a mean stent graft diameter of 27.8 ± 1.7 mm. During the long-term follow-up (mean period: 104.6 ± 51.9 months), 12 patients died of non-aortic events and 5 distal aortic reoperations were required using endovascular stent grafting of the descending aorta, including 1 case with new tear formation. None of the patients had a patent false lumen on the stent graft at the final follow-up. The 10-year survival rate was 75% and the overall 10-year reoperation-free rate on the thoracic aorta was 93%.ConclusionsThe FET technique results in excellent aortic remodelling of the downstream aorta and can improve the long-term outcomes for AAAD.© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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