| Authors | Year | Mortality | Paraplegia |
| Baraki et al. | 2007 | 5/39 (12.8%) | 0/39 (0%) |
| Liu et al. | 2006 | 2/60 (3.3%) 1/60 | (1.6%) |
| Uchida et al. | 2006 | 2/35 (5.7%) | 0/35 (0%) |
| Flores et al. | 2006 | 3/25 (12%) | 4/25 (16%) |
Due to the option of antegrade cerebral perfusion via the right subclavian artery, procedures requiring hemi-arch replacement or open distal anastomosis can also be carried out with very good short-term and long-term results. This is because:
However, operations on the aortic arch are still associated with considerable surgical risk. For this reason, not only conventional complete aortic arch replacement (with implantation of the supra-aortic branches as an island or separate prosthesis replacement for the supra-aortic branches), but also aortic arch replacement using a hybrid procedure can be carried out. The results of the hybrid aortic arch procedure are shown in Table 2.1-2.
Reliable data for the frozen elephant trunk operation are also available in the Ross Registry (Sievers et al. 2005). The study shows that the operation offers an excellent survival rate. The overall rate of repeat valvular surgery is very low with autografts, but the frequency of repeat surgery with allografts (in the pulmonary artery position) has been markedly increasing during the medium term among pediatric patients (Bechtel and Sievers 2005).
2.1.8 Prospects
Diseases of the thoracic aorta are likely to increase during the coming years. This is due to the general increase in life expectancy, as well as the fact that patients with arterial hypertension still do not yet have universal access to good treatment. Although tremendous advances have been made during the last 10 years in this field in particular, the short-term and long-term results are likely to improve even further as a result of innovations in surgical treatment in the thoracic aorta, with endovascular stent implantation and also improvements in the conventional surgical technique. Fenestrated and branched endovascular stents are particularly promising for further improvements in the aortic arch and at the thoracoabdominal junction. A new treatment approach, the implantation of, what is known as a Multilayer Aneurysm Repair System (MARS) stent, may in the coming years make it unnecessary to use branched endoprostheses or hybrid procedures with a debranching operation before endoprosthesis implantation. However, this approach involving modulation of the flow inside an aneurysmal sac, thereby inducing thrombosis of the aneurysm and local pressure reduction, will require further validation of its clinical value to be confirmed in the region of the abdominal aorta and thoracoabdominal aorta first, before it can be used to treat cerebral arteries. It is important that patients with these conditions should be referred to the relevant specialist centers in which the whole range of diagnosis and treatment is available, so that the best individual treatment strategy for each patient can be selected.
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