Neurological Complications Following Frozen Elephant Trunk for Aortic
Dissection: What’s Truly to Blame?
Abstract
Total arch repair (TAR) has become a mainstay of the surgical management
of complex pathologies of the ascending aorta and aortic arch, in
particular acute Type A aortic dissections (ATAAD). TAR with devices
such as the frozen elephant trunk (FET) have been shown to dramatically
improve clinical outcomes in such cases. However, TAR with FET remains
an immensely challenging procedure, and the risk of debilitating
postoperative complications remains high. Spinal cord ischaemia (SCI)
and stroke are two particularly tragic adverse outcomes of TAR with FET;
it is unsurprising therefore that much research has been done to
determine both the underlying cause thereof, and strategies to mitigate
this risk. Mousavizadeh and colleagues produced a fascinating systematic
review and meta-analysis investigating the relationship between the
duration of hypothermic circulatory arrest (HCA) and the risk of
developing complications including SCI and stroke. Their data seem to
suggest HCA duration is a key factor in causing SCI and stroke following
TAR with FET for ATAAD. However, other factors such as stent sizing and
landing zone also contribute. Further prospective research into this
relationship is recommended to fully elucidate what truly is to blame
for these postoperative neurological complications.