Correlation of coagulopathy and frozen elephant trunk use in aortic arch surgery: A systematic review and meta‐analysis

Idhrees²,

Bashir

2022

Aorta (Stamford)

Self Cite

There is currently no standard, evidence-based approach for sizing the Thoraflex Hybrid prosthesis in frozen elephant trunk surgery. We present regional data on 906 Thoraflex grafts implanted in the United Kingdom between December 2012 and August 2021 to emphasize the heterogeneity in sizing practices and evaluate the impact this may have on clinical outcomes. Highlighting this heterogeneity will help develop an evidence-based approach to prosthesis sizing, thereby aiding decision-making for arch repair.

Section: Discussionmentioning

confidence: 99%

“… 2 Tan et al 2 recently published a comprehensive dataset of clinical outcomes associated with 931 Thoraflex HP implantations in an assessment of its long-term clinical efficacy, and a recent systematic review suggested that Thoraflex HP was associated with lower rates of coagulopathy-related complications than other devices. 3 …”

Section: Introductionmentioning

confidence: 99%

Frozen Elephant Trunk Sizing: A 30,000-Feet Perspective with Thoraflex Hybrid Stent Graft

Idhrees²,

Bashir

2022

Aorta (Stamford)

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“…A recent systematic review by Bashir et al including 6,313 patients treated with Thoraflex Hybrid TM , E-Vita TM , Frozenix TM , and Cronus TM found that publications detailing coagulopathic events following Thoraflex Hybrid TM and Frozenix TM implantation were associated with the least degree of heterogeneity compared to the 3 market alternatives (I 2 = 0.01%, I 2 = 53.95%, I 2 = 0.01%, and I 2 = 54.41%, respectively) (31). Furthermore, while Thoraflex Hybrid TM has hitherto not been associated with major prosthesis-caused coagulopathic events, several recent reports by Ho et al and Czerny et al have revealed that E-Vita TM Open NEO has a propensity for catastrophic oozing from the arch graft portion (32,33).…”

Section: Coagulopathy and Reinterventionmentioning

confidence: 99%

What Is the Long-Term Clinical Efficacy of the Thoraflex™ Hybrid Prosthesis for Aortic Arch Repair?

Front. Cardiovasc. Med.

Jubouri

Idhrees³

et al. 2022

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BackgroundThe widespread adoption of the frozen elephant trunk (FET) technique for total arch reconstruction (TAR) in aortic arch aneurysm and dissection has led to the development of numerous commercial single-piece FET devices, each with its own unique design features. One such device, Thoraflex™ Hybrid (Terumo Aortic, Glasgow, Scotland), has enjoyed widespread use since its introduction. We present and appraisal of its long-term clinical efficacy, based on international data.Materials and MethodsPre-, intra-, and postoperative data associated with Thoraflex™ Hybrid implantations for aortic arch dissection, aneurysm, and penetrating atherosclerotic ulcer (PAU) up to April 2019 was gathered and is presented herein. Follow-up data at discharge, 3-, 6-, 12-, 24-, 36-, 48-, 60-, 72-, and 84- months post-implantation are included.ResultsData associated with 931 cases of Thoraflex™ Hybrid implantation are included. Mean age at implantation was 63 ± 12 years. 55% of patients included were male. Aortic dissection accounted for 48% (n = 464) of cases. Mean cardiopulmonary bypass and circulatory arrest durations were 202 +72 and 69 ± 50 min, respectively. 30-day mortality was 0.6% (n = 6), while overall mortality was 14 (1.5%). Freedom from adverse events at 84 months was 95% (n = 869). Postoperative complications included neurological deficit, multi-organ failure, cardiorespiratory compromise, and infection.DiscussionThoraflex™ Hybrid's unique design is advantageous in comparison to market alternatives. Our data is consistent with that reported in literature and suggests Thoraflex™ Hybrid is associated with favourable rates of mortality and morbidity.ConclusionThoraflex™ Hybrid remains a central player in the aortic arch prosthesis market. Its use it widespread and is associated with favourable design features and clinical outcomes relative to market alternatives.

“…9,12,16,17 It is worth noting that THP remains associated with the lowest rate of re-operation for bleeding when compared to other commercially available FET devices. 18 Although several strategies have been discussed in literature to mitigate the risk of reintervention, the THP has yielded favourable results when it comes to endovascular secondary reintervention. 19 A recent scoping review of the literature indicated that the incidence of post-FET distal stent-graft induced new re-entry (dSINE) ranges from 0% to 14.5% among patients who were treated with THP, 16,[20][21][22] and secondary endovascular repair has shown excellent results.…”

Section: Ascyrus Medical Dissection Stent (Amds)mentioning

confidence: 99%

Thoraflex Hybrid vs. AMDS: To replace the arch or to stent it in type A aortic dissection?

Al‐Tawil

Jubouri

Asian Cardiovasc Thorac Ann

et al. 2022

Self Cite

Background Acute type A aortic dissection (ATAAD) is a life-threatening medical emergency that requires urgent surgical intervention. The mainstay surgical approach to treating ATAAD with aortic arch involvement is total arch replacement (TAR). The frozen elephant trunk (FET) procedure involves TAR with hybrid endovascular stenting of the DTA in a single step using a hybrid prosthesis (HP). The prime example of a FET HP is Thoraflex Hybrid Prosthesis (THP). Another treatment option is the novel Ascyrus Medical Dissection Stent (AMDS) that is deployed as a non-covered stent along with the aortic arch as an adjunct to prior hemi-arch replacement. Aims This comparative review highlights the clinical applications and outcomes of THP and AMDS in the treatment of ATAAD and discusses the main differences between both approaches. Methods A comprehensive literature search was conducted using multiple electronic databases including PubMed, Google Scholar, Ovid, Scopus and Embase. Results TAR with FET can be considered the superior approach to managing ATAAD with arch involvement relative to AMDS with hemi-arch replacement due to more optimal clinical outcomes. Upon comprehensively searching the literature, early mortality was substantially lower with FET ranging from 0–11% compared to 12.5–18.7% using AMDS, with more favourable long-term survival. The incidence of kidney injury and new stroke post-FET ranged from 3–20% and 5–16%, and 11–37.5% and 0–18.8% following AMDS implantation. However, evidence supporting the use of AMDS is extremely limited. Meanwhile, TAR with FET is a well-established and well-described procedure for ATAAD repair. Conclusion Despite the novel nature of AMDS, its clinical safety and effectiveness are yet to be proven. In conclusion, THP remains the best evidenced-based approach to treat ATAAD in this era.