Surgical treatment of complex aneurysms and thoracic aortic dissections with the frozen elephant trunk technique

Abstract

ObjectiveReport initial experience with the Frozen Elephant Trunk technique.MethodsFrom July 2009 to October 2013, Frozen Elephant Trunk technique was performed in 21 patients (66% male, mean age 56 ±11 years). They had type A aortic dissection (acute 9.6%, chronic 57.3%), type B (14.3%, all chronic) and complex aneurysms (19%). It was 9.5% of reoperations and 38% of associated procedures (25.3% miocardial revascularization, 25.3% replacement of aortic valve and 49.4% aortic valved graft). Aortic remodeling was evaluated comparing preoperative and most recent computed tomography scans. One hundred per cent of complete follow-up, mean time of 28 months.ResultsIn-hospital mortality of 14.2%, being 50% in acute type A aortic dissection, 8.3% in chronic type A aortic dissection, 33.3% in chronic type B aortic dissection and 0% in complex aneurysms. Mean times of cardiopulmonary bypass (152±24min), myocardial ischemia (115±31min) and selective cerebral perfusion (60±15min). Main complications were bleeding (14.2%), spinal cord injury (9.5%), stroke (4.7%), prolonged mechanical ventilation (4.7%) and acute renal failure (4.7%). The need for second-stage operation was 19%. False-lumen thrombosis was obtained in 80%.ConclusionFrozen Elephant Trunk is a feasible technique and should be considered. The severity of the underlying disease justifies high mortality rates. The learning curve is a reality. This approach allows treatment of more than two segments at once. Nonetheless, if a second stage is made necessary, it is facilitated.

The learning curve effect on outcomes with frozen elephant trunk technique for extensive thoracic aorta disease

“…Dias et al, when publishing the initial experience of the group, emphasized that not only the severity of the underlying disease, the percentage of reoperations and the high number of associated procedures but also the learning curve could influence the results of the procedure.…”

“…Thus, our results confirmed that the need for reintervention is due to the characteristics of the primary disease, and not because of the failure of FET's prosthesis. Besides, FET simplified reintervention in the distal segments, providing a more appropriate landing zone for endovascular completion …”

“…Thus, our results confirmed that the need for reintervention is due to the characteristics of the primary disease, and not because of the failure of FET's prosthesis. Besides, FET simplified reintervention in the distal segments, providing a more appropriate landing zone for endovascular completion 8,13,14. Interestingly, the application of the FET procedure has significantly increased over recent years, including acute aortic dissection.In this context, a strong argument favoring the FET procedure includes complex arch tears and distal aortic malperfusion.…”

Simplified total aortic arch replacement with an in situ stent graft fenestration technique for acute type A aortic dissection

“…With our in situ stent graft fenestration technique, anastomosis of the LSA was simplified, and the circulatory arrest time was shorter in our study than in the study by Dias et al (23.28 6 5.56 minutes vs 40 6 8 minutes). 15 In addition, the results of cerebral complication were encouraging as only five (4.7%) patients had transient neurologic dysfunction, and no permanent neurologic dysfunction occurred.…”

Key points of reducing neurologic complications in frozen elephant trunk technique

“…We have read the interesting article entitled "Surgical treatment of complex aneurysms and thoracic aortic dissections with the Frozen Elephant Trunk technique" carefully [ 1 ] . The authors report their initial experience with this technique in 21 patients.…”