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Neurological Complications Following Frozen Elephant Trunk for Aortic Dissection: What’s Truly to Blame?
  • Sven Zhen Cian Patrick Tan,
  • Hazem Elsantawy,
  • Amr Abdelhaliem
Sven Zhen Cian Patrick Tan
Queen Mary University of London Barts and The London School of Medicine and Dentistry
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Hazem Elsantawy
Royal Blackburn Hospital
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Amr Abdelhaliem
East Lancashire Hospitals NHS Trust
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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.

Peer review status:ACCEPTED

23 May 2021Submitted to Journal of Cardiac Surgery
24 May 2021Assigned to Editor
24 May 2021Submission Checks Completed
24 May 2021Editorial Decision: Accept