Comparison of the conventional frozen elephant trunk implantation technique with a modified implantation technique in zone 1

Abstract

OBJECTIVES The aim of the study was to compare the conventional frozen elephant trunk implantation technique with a modified implantation technique with an aortic anastomosis in zone 1 and extra-anatomic revascularization of the left subclavian artery during reperfusion. METHODS Between May 2014 and March 2018, 40 patients (26 male; mean age 60.2 ± 11.2 years) underwent complete aortic arch replacement with the Thoraflex Hybrid prosthesis™ (Vascutek, Inchinnan, Scotland) at our institution. Seventeen patients underwent conventional arch replacement (group 1) and 23 patients the modified procedure (group 2). Indication for arch replacement included all types of acute and chronic diseases. RESULTS Cardiopulmonary bypass time (213.1 ± 53.5 vs 243.8 ± 67.0 min, P = 0.13) and aortic cross-clamp time (114.4 ± 40.7 vs 117.3 ± 56.6 min, P = 0.86) did not differ significantly between group 1 and 2. There was a trend towards a shorter circulatory arrest time (50.72 ± 9.6 vs 44.7 ± 15.5 min; P = 0.20) in group 2. Perioperative mortality was 10% (5.9% vs 13%; P = 0.62). Stroke occurred in 10% (5.9% vs 13%; P = 0.62) of patients. Spinal cord injury occurred in 7.5% of patients (11.8% vs 4.3% P = 0.57). Due to the a proximal aortic anastomosis, there was a significantly shorter coverage of the descending aorta with the prosthesis ending at vertebral level Th7.5 (6.75–8) in group 1 versus Th6.0 (5.0–6.0) in group 2 (P-value = 0.004). CONCLUSIONS Implantation of the frozen elephant trunk prosthesis in zone 1 allows for a more proximal aortic anastomosis that could make the procedure more feasible especially in patients with difficult anatomies or in an acute setting.

Taking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study

“…Several modifications have been proposed to facilitate the FET procedure. The complexity of the FET procedure can be decreased by moving the distal anastomosis from zone 3 to zone 2 or 1 [ 26 ]. Proximalization of the distal anastomosis facilitates the performance of the anastomosis with the aorta and reduces the incidence of left recurrent laryngeal nerve injury.…”

Is total arch replacement associated with an increased risk after acute type A dissection?

“…The use of FET prostheses in our patient population with first-time aortic arch replacement is rare with only 2.1% (7/47patients) though many advantages are proposed. The current strategy is to implant the FET in zone I or II of the aortic arch and bypass the left subclavian artery or any supraaortal vessel even in experienced aortic centers to reduce longer operation times, which reflects the complexity of FET prosthesis implantation methods to the descending aorta (14,15).…”

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

“…Of 64 studies reporting outcomes of patients included in this report 13–76 . The proportions of studies from Asia, Europe, and North America were 54.7%, 31.3%, and 10.9%, respectively.…”