A modified frozen elephant trunk hybrid device to facilitate supra‐aortic trunk anastomosis

Masiello, Paolo; Mastrogiovanni, Generoso; Chivasso, Pierpaolo; Triggiani, Donato; Cafarelli, Francesco Pio; Iesu, Severino

doi:10.1111/jocs.15208

Cited by 7 publications

(8 citation statements)

References 7 publications

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“…In one case, not included in this series, we successfully used a custom-made Thoraflex Hybrid, in which the plexus is separated from the main part of the prosthesis, to make anastomosis easier, improve operating times and correctly position the intra-thoracic vessels. 15 Overall survival for the entire cohort at 30 days was 90% (95% CI, 83.2-97.3), without statistically significant differences between emergency and elective surgery (87.9% vs. in emergency vs. 93.2% in chronic settings, p = .312).…”

Section: Resultsmentioning

confidence: 88%

Frozen elephant trunk procedure for complex aortic arch surgery: The Salerno experience with Thoraflex hybrid

Masiello

Mastrogiovanni

Presutto

et al. 2021

Journal of Cardiac Surgery

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Background and Aim of the Study To report early clinical outcomes of the frozen elephant trunk (FET) technique for the treatment of complex aortic diseases after transition from conventional elephant trunk. Methods A single‐center, retrospective study of patients who underwent hybrid aortic arch and FET repair for aortic arch and/or proximal descending aortic aneurysms, acute and chronic Stanford type A aortic dissection with arch and/or proximal descending involvement, Stanford type B acute and chronic aortic dissections with retrograde aortic arch involvement. Results Between December 2017 and May 2020, 70 consecutive patients (62.7 ± 10.6 years, 59 male) were treated: 41 (58.6%) for emergent conditions and 29 (41.4%) for elective. Technical success was 100%. In‐hospital mortality was 14.2% (n = 12, 17.1% emergent vs. 10.3% elective, P = NS); 2 (2.9%) major strokes; 1 (1.4%) spinal cord injury. Mean follow‐up was 12.5 months (interquartile range, 3.7–22.3). Overall survival at 3, 6, 12, and 24 months was 90% (95% confidence interval [CI], 83.2—97.3), 85.6% (95% CI, 77.7–94.3), 79.1% (95% CI, 69.9–89.5), 75.6% (95% CI, 65.8–86.9) and 73.5% (95% CI, 63.3–85.3). There were no aortic re‐interventions and no distal stent graft‐induced new entry (dSINE); 5 patients with residual type B dissection underwent TEVAR completion. Conclusions In a real‐world setting, FET with Thoraflex Hybrid demonstrated feasibility and good clinical outcomes, even in emergent setting. Our implant technique optimize cerebral perfusion reporting good results in terms of neurological complications. Techniques to perfect the procedure and to reduce remaining risks, and consensus on considerations such as standardized cerebral protection need to be reported.

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Section: Resultsmentioning

confidence: 88%

Frozen elephant trunk procedure for complex aortic arch surgery: The Salerno experience with Thoraflex hybrid

Masiello

Mastrogiovanni

Presutto

et al. 2021

Journal of Cardiac Surgery

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“…As previously reported by our group [18], in our institution, the right intrathoracic subclavian artery is routinely employed as the site for central cannulation. Its exposure is facilitated by extending the usual sternotomy incision in a small right supra-clavicular cervicotomy.…”

Section: Cannulation Strategymentioning

confidence: 74%

“…In our opinion, the claimed technical challenge of this technique should not represent a limit to its use in acute settings. The contemporary concept of specialized centers with a high volume of aortic surgery treating both chronic and acute aortic syndrome is now becoming dominant and possibly changing the surgical approach [18]. There is a substantial unanimity on the idea that patients affected by acute aortic syndromes may well gain advantages from treatment at dedicated specialized aortic centers, with significantly improved results and decreased mortality [44][45][46].…”

Section: Discussionmentioning

confidence: 99%

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Frozen Elephant Trunk Technique in Acute Type A Aortic Dissection: Is It for All?

et al. 2021

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Acute type A aortic dissection (ATAAD) is an indisputable emergency with very poor outcomes without surgical treatment. Although the aortic arch is often involved in the aortic dissection, its optimal management during surgical therapy remains uncertain. A conservative tear-oriented approach has traditionally been adopted, limiting the procedure to the ascending aorta (or hemiarch) replacement. However, dilation of the residual dissected aorta and subsequent rupture may occur, requiring further intervention in the future. In the last two decades, the frozen elephant trunk (FET) technique has become a valid and attractive option to treat aortic disease when the arch and the thoracic aorta are involved, both in elective and in emergency settings. Here, we report a review of the contemporary literature regarding the short- and long-term outcomes of the FET technique in ATAAD repair.

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“…In one case, not included in this series, we successfully used a custom-made Thoraflex Hybrid, in which the plexus is separated from the main part of the prosthesis, in order to make anastomosis easier, improve operating times and correctly position the intra-thoracic vessels. 15 Overall survival for the entire cohort at 30 days was 90% (95% CI, 83.2-97.3), without statistically significant differences between emergency and elective surgery (87.9% vs. in emergency vs. 93.2% in chronic settings, P=0.312).…”

Section: Discussionmentioning

confidence: 88%

Clinical outcomes of the Frozen Elephant Trunk procedure in 70 emergent and elective patients undergoing aortic arch surgery: the Salerno experience with Thoraflex Hybrid

Masiello

Mastrogiovanni

Presutto

et al. 2021

Preprint

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Background and aim of the study. To report early clinical outcomes of the frozen elephant trunk technique (FET) for the treatment of complex aortic diseases after transition from conventional elephant trunk. Methods. A single-center, retrospective study of patients who underwent hybrid aortic arch and FET repair for aortic arch and/or proximal descending aortic aneurysms, acute and chronic Stanford type A aortic dissection with arch and/or proximal descending involvement, Stanford type B acute and chronic aortic dissections with retrograde aortic arch involvement. Results. Between December 2017 and May 2020, 70 consecutive patients (62.7±10.6 years, 59 male) were treated: 41 (58.6%) for acute conditions and 29 (41.4%) for chronic. Technical success was 100%. In-hospital mortality was 14.2% (n=12, 17.1% emergency vs. 10.3% chronic, P=NS); 2 (2.9%) major strokes; 1 (1.4%) spinal cord injury. Follow-up was 12.5 months (IQR 3.7—22.3. Overall survival at 3, 6, 12 and 24 months was 90% (95% CI, 83.2—97.3), 85.6% (95% CI, 77.7—94.3), 79.1% (95% CI, 69.9—89.5), 75.6% (95% CI, 65.8—86.9) and 73.5 (95% CI, 63.3—85.3). There were no aortic re-interventions and no dSINE; 5 patients with residual type B dissection underwent TEVAR completion. Conclusions. In a real-world setting, FET demonstrated a rapid learning curve and good clinical outcomes, even in acute type A aortic dissections. Techniques to perfect the procedure and to reduce remaining risks, and consensus on considerations such as standardized cerebral protection need to be reported.

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A modified frozen elephant trunk hybrid device to facilitate supra‐aortic trunk anastomosis

Cited by 7 publications

References 7 publications

Frozen elephant trunk procedure for complex aortic arch surgery: The Salerno experience with Thoraflex hybrid

Frozen elephant trunk procedure for complex aortic arch surgery: The Salerno experience with Thoraflex hybrid

Frozen Elephant Trunk Technique in Acute Type A Aortic Dissection: Is It for All?

Clinical outcomes of the Frozen Elephant Trunk procedure in 70 emergent and elective patients undergoing aortic arch surgery: the Salerno experience with Thoraflex Hybrid

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