Predictors of early adverse events after the frozen elephant trunk procedure

Kozlov B.N.^1,2, Panfilov D.S.^1,2, Lukinov V.L.³

¹ Department of Cardiovascular Surgery, Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences,
² Department of Hospital Surgery with a Course of Cardiovascular Surgery, Siberian State Medical University of the RF Ministry of Public Health, Tomsk,
³ Institute of Computational Mathematics and Mathematical Geophysics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia

Objective. The aim of this study was to identify predictors of adverse events after the frozen elephant trunk procedure in the early postoperative period.

Patients and methods. Between March 2012 and March 2020, a total of 273 patients were operated on for aortic pathology. A retrospective analysis aimed at identifying probable predictors was performed on 83 patients who underwent the FET procedure. Uni- and multivariate logistic regression was used to identify predictors of such adverse events as postoperative delirium, respiratory failure, acute kidney injury, and in-hospital mortality.

Results. According to the findings of the optimal multivariate regression model, separate reimplantation of the supra-aortic branches was a significant predictor of postoperative delirium (OR 10.41; 95% CI 1.1–35.45; p=0.05); significant risk factors for prolonged respiratory support were the duration of surgery (OR 1.02; 95% CI 1.01–1.03; p<0.001) and postoperative acute renal injury (OR 8.72; 95% CI 1.67–57.38; p=0.014). Independent risk factors for postoperative renal injury turned out to be the true lumen diameter of the descending aorta (OR 1.3; 95% CI 1.1–1.72; p=0.015) and chronic type A aortic dissection (OR 44.07; 95% CI 3.29–2354.8; p=0.014); statistically significant risk factors for in-hospital mortality were multiple organ dysfunction syndrome (OR 14.34; 95% CI 1.69–155.48; p=0.016) and coronary artery stenosis (OR 3.36; 95% CI 1.19–13.26; p=0.042).

Conclusion. Separate reimplantation of the supra-aortic branches, duration of surgery, acute kidney injury, chronic aortic dissection, multiple organ dysfunction syndrome, true lumen diameter of the descending aorta, coronary atherosclerosis and haemoglobin level were statistically significant predictors of adverse events in the early postoperative period.

KEY WORDS: thoracic aorta, frozen elephant trunk, predictors, delirium, acute kidney injury, mortality.

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