Aortic reinterventions after the frozen elephant trunk procedure

Kreibich, Maximilian; Berger, Tim; Rylski, Bartosz; Chen, Zehang; Beyersdorf, Friedhelm; Siepe, Matthias; Czerny, Martin

doi:10.1016/j.jtcvs.2019.02.069

Cited by 80 publications

(81 citation statements)

References 22 publications

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“…To date, there have been few reports about the mid-term or long-term outcomes of the FET technique for CAD. [9][10][11][12][13] Di Eusanio et al 9) reported short-and mid-term results after treatment of CAD with FET using the E-vita Open and E-vita Open plus (JOTEC ® GmBH, Hechingen, Germany) devices. In their 49 patients, the hospital mortality rate was 10.2%, the neurological morbidity rate was 6.1%, and the spinal cord injury (SCI) rate was 10.2%.…”

Section: Discussionmentioning

confidence: 99%

Mid-Term Results of Frozen Elephant Trunk Technique for Chronic Aortic Dissection

Yamane

Katayama

Furukawa

et al. 2020

Annals of Vascular Diseases

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In this study, we report our experience using the frozen elephant trunk (FET) technique for chronic aortic dissection. Methods: Between January 2011 and December 2017, 15 patients underwent total arch replacement (TAR) with the FET technique for chronic aortic dissection (CAD). Results: Hospital mortality was 6.7% (n=1). No patients experienced spinal cord injury. Distal stent-induced new entry (dSINE) occurred in the early postoperative period in one patient. There were four unplanned additional operations to manage dSINE. Five patients suffered from dSINE, and aortoesophageal fistula developed in three of them. Short insertion length of the FET and large angle between the distal edge of the FET and the descending aorta were significantly more common in the dSINE group than in the non-dSINE group. The cumulative survival rates at 1, 3, and 5 years were 93.3%, 93.3%, and 66.4%, respectively. The cumulative aortic event-free rates at 1, 2, and 3 years were 85.7%, 77.1%, and 52.9%, respectively. Conclusion:The FET technique for CAD provided good early results. Short insertion length of the FET, however, can induce dSINE, which requires an additional operation at mid-term. Thus, surgical indication of the FET technique for CAD must be discussed.

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Section: Discussionmentioning

confidence: 99%

Mid-Term Results of Frozen Elephant Trunk Technique for Chronic Aortic Dissection

Yamane

Katayama

Furukawa

et al. 2020

Annals of Vascular Diseases

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“…Although a pooled analysis showed that aortic arch repair in patients with TAAD can be performed without increased risk [ 3 ], previous studies [ 16 ] and our experience showed that aortic arch surgery was associated with increased mortality (30-day: 25.2% vs. 14.6%; 10-year: 53.3% vs. 33.6%, adjusted HR 2.770, 95%CI 1.562–4.913). Furthermore, most studies demonstrated that aortic arch repair with or without the use of frozen elephant trunk technique seems not to decrease the risk of distal aortic reoperation [ 6 , 7 , 8 , 9 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], whose freedom rates at 10 years may range from 78.0% to 92.9% [ 17 , 21 ]. We recognize that there are also studies from series including mostly ascending aorta/hemiarch repairs reporting 10-year freedom from reoperation as low as 61% to 78% [ 15 , 23 ], and decreased aortic reoperations after total arch replacement [ 15 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…These extensive aortic interventions are supposed to protect the fragile remaining aorta from degeneration and to confer a reduction in volume and lead to thrombosis of the false lumen. However, these procedures can be associated with adverse events [ 5 ] and do not completely prevent late events [ 6 , 7 , 8 , 9 ]: these aspects may not justify their associated increased risks and costs. In this scenario of uncertainty, evaluation of the long-term outcome after surgery for TAAD is of importance to estimate the risk of late aortic-related complications and to identify patients who may most benefit from a more extensive surgical and/or completion endovascular procedure.…”

Section: Introductionmentioning

confidence: 99%

Late Outcome after Surgery for Type-A Aortic Dissection

Jormalainen

Raivio

Biancari

et al. 2020

JCM

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The aim of this study was to evaluate all-cause mortality and aortic reoperations after surgery for Stanford type A aortic dissection (TAAD). We evaluated the late outcome of patients who underwent surgery for acute TAAD from January 2005 to December 2017 at the Helsinki University Hospital, Finland. We studied 309 patients (DeBakey type I TAAD: 89.3%) who underwent repair of TAAD. Aortic root repair was performed in 94 patients (30.4%), hemiarch repair in 264 patients (85.4%) and partial/total aortic arch repair in 32 patients (10.4%). Hospital mortality was 13.6%. At 10 years, all-cause mortality was 34.9%, and the cumulative incidence of aortic reoperation or late aortic-related death was 15.6%, of any aortic reoperation 14.6%, reoperation on the aortic root 6.6%, on the aortic arch, descending thoracic and/or abdominal aorta 8.7%, on the descending thoracic and/or abdominal aorta 6.4%, and on the abdominal aorta 3.8%. At 10 years, cumulative incidence of reoperation on the distal aorta was higher in patients with a diameter of the descending thoracic aorta ≥35 mm at primary surgery (cumulative incidence in the overall series: 13.2% vs. 4.0%, SHR 3.993, 95%CI 1.316–12.120; DeBakey type I aortic dissection: 13.6% vs. 4.5%, SHR 3.610, 95%CI 1.193–10.913; patients with dissected descending thoracic aorta: 15.8% vs. 5.9%, SHR 3.211, 95%CI 1.067–9.664). In conclusion, surgical repair of TAAD limited to the aortic segments involved by the intimal tear was associated with favorable survival and a low rate of aortic reoperations. However, patients with enlarged descending thoracic aorta at primary surgery had higher risk of late reoperation. Half of the distal aortic reinterventions were performed on the abdominal aorta.

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“…Using fluoroscopy with contrast enhancement after circulatory arrest is perceived to be nephrotoxic and is not routinely performed in our center for that reason. Kreibich et al 4 reported an 11% incidence of distal SINE after frozen elephant trunk implantation, most in chronic dissections. In these cases, they tended to use the smallest possible frozen elephant trunk prosthesis as a preventive measure.…”

Section: Discussionmentioning

confidence: 99%

Rapid false lumen dilation and pseudocoarctation due to inadvertent preferential false lumen perfusion using the frozen elephant trunk technique in a chronic residual aortic dissection

Fleerakkers

Sonker

Heijmen

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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A patient with a chronic postdissection distal arch aneurysm was treated with total arch replacement and frozen elephant trunk. Following uneventful initial recovery, the frozen elephant trunk appeared to be inadvertently perfusing the false lumen through an already present (in retrospect) intimal tear, resulting in rapid dilation of the false lumen and proximal compression of the graft. Treatment consisted, first, of endovascular redirection of flow toward the distal true lumen and, second, open surgical repair of the remaining type IV aneurysm. This case underlines the importance of scrutinizing preoperative imaging for correct use of the frozen elephant trunk. (J Vasc Surg Cases and Innovative Techniques 2020;6:101-3.)

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Aortic reinterventions after the frozen elephant trunk procedure

Cited by 80 publications

References 22 publications

Mid-Term Results of Frozen Elephant Trunk Technique for Chronic Aortic Dissection

Mid-Term Results of Frozen Elephant Trunk Technique for Chronic Aortic Dissection

Late Outcome after Surgery for Type-A Aortic Dissection

Rapid false lumen dilation and pseudocoarctation due to inadvertent preferential false lumen perfusion using the frozen elephant trunk technique in a chronic residual aortic dissection

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