Aortic arch replacement in patients with previous repair of acute aortic dissection: a systematic review and meta-analysis.

Objectives: Despite the popularity of the frozen elephant technique procedure in recent years, evidence is scarce regarding its utilization for aortic arch replacement following previous acute aortic dissection repair. In this systematic review and meta-analysis, we aimed to analyse clinical outcomes of aortic arch replacement in patients with previous repair of acute aortic dissection.

Methods: A systematic literature search on PubMed, MEDLINE via Ovid, Embase, Scopus, and Web of Science until March 2024 was performed for studies on open aortic arch replacement with or without frozen elephant technique procedure in adult patients after previous acute aortic dissection repair. Early and late postoperative mortality were primary, while postoperative complications were secondary outcomes of interest. Additionally, a meta-analysis was performed to pool the early and late postoperative mortality.

Results: A total of 574 studies were identified, of which 9 studies including a total of 677 patients met the eligibility criteria. In-hospital or 30-day postoperative mortality and stroke were 0-17.5% and 0-7.7%, respectively. Duration of follow-up across all studies varied from 1.1 to 5.1 years. All-cause late mortality rate ranges from 5.9% to 30.5%. Aortic reintervention rate was 4.8-38.7%. The pooled early and late mortality rate were 8.7% [95% confidence interval (CI) 5.7-13%; I2 = 52%] and 24.9% (95% CI 19.5-31.1%; I2 = 54%), respectively.

Conclusions: Current evidence suggest that relatively younger patients with chronic post-dissection aneurysm or residual aortic dissection after acute aortic dissection repair can undergo an aortic arch replacement by a dedicated aortic team with acceptable mortality risk. However, postoperative neurological deficit remains an issue.