Mortality and neurologic complications after repair of aortic arch pathology: a systematic review with meta-analysis

Abstract

Introduction: Frozen elephant trunk (FET) technique was developed as an alternative to the conventional elephant trunk (cET) procedure for the repair of complex aortic arch pathology. However, short term results between these different procedures are sparsely described. This systematic review with meta-analysis aimed to compare short term outcomes between FET and cET in the repair of aortic arch pathology. Evidence acquisition: PubMed, Web of Science and Scopus electronic databases were searched for studies comparing performance of FET and cET procedures in patients with aortic arch pathology. The primary outcome of interest was early mortality, defined as 30-day or in-hospital mortality. Secondary outcomes were stroke, and spinal cord ischemia (SCI). Meta-analysis utilizing the random-effects model was performed using Review Manager (RevMan) software, version 5.4. Evidence synthesis: Ten studies, comprising 1481 patients with aortic arch pathology, were included. Meta-analysis demonstrated statistically significant reduction of early mortality (odds ratio [OR], 0.63; 95% CI, 0.41-0.97) in the FET group. For neurologic outcomes, no significant differences were noted in stroke risk between both groups (OR, 1.21; 95% CI, 0.83-1.75), but an increased risk of SCI was present in FET patients (OR, 2.07; 95% CI, 1.05-4.10). Conclusions: FET appears to be associated with a significant lower early mortality, at costs of greater SCI risk. Larger studies are needed to provide confident recommendations towards preferential use of either procedure.