Thrombotic complications after aortic arch replacement with frozen elephant trunk stent-graft: A 10-year United Kingdom institutional experience

Objective

Postoperative intraluminal thrombosis after frozen elephant trunk replacement has been reported to occur with a frequency of 6% to 17% and is associated with poor outcomes. The purpose of this institutional review is to analyze thrombosis rate, predisposing patient and operative factors, and assess different anticoagulation regimens.

Methods

This retrospective cohort study includes 174 patients operated on over 10 years. one hundred forty-five of these underwent elective aortic arch replacement; 29 had the procedure for Type A aortic dissection repair.

Results

Sixteen elective (11%) and 3 dissection patients (10%) had radiographic evidence of intraluminal thrombus. There were no statistical differences in demographic or intraoperative characteristics between the 2 groups. Of the 16 elective patients with thrombus, 12 (75%) had aneurysmal disease. Central graft position is associated with a higher incidence of intraluminal thrombus formation than eccentric position in both cohorts, 17% versus 7% in elective patients and 15% versus 0% in the dissection group. Patients with intraluminal thrombosis had significantly lower 6-month survival in both cohorts (69% vs 92% and 66% vs 88%; P = .0037) and this was also true for the elective group (69% vs 96%; P = .0001). Of several anticoagulation regimens employed over the study period, early introduction of warfarin proved superior.

Conclusions

The incidence of thrombus formation is higher in patients with aneurysmal disease and when the graft is positioned centrally. Early anticoagulation with warfarin appears to be protective. We advocate the creation of a registry to help improve outcomes after this complex surgery.