Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS

Shrestha, Malakh; Bachet, Jean; Bavaria, Joseph E.; Carrel, Thierry; Paulis, Ruggero De; Bartolomeo, Roberto Di; Etz, Christian D.; Grabenwöger, Martin; Grimm, Michael; Haverich, Axel; Jakob, Heinz; Martens, Andreas; Mestres, Carlos A.; Pacini, Davide; Resch, Timothy; Schepens, Marc A.A.M.; Urbanski, Paul P.; Czerny, Martin

doi:10.1093/ejcts/ezv085

Cited by 275 publications

(218 citation statements)

References 71 publications

(54 reference statements)

Supporting

Mentioning

206

Contrasting

Unclassified

Order By: Relevance

“…Such extensive approaches are designed to promote false lumen thrombosis to effectively prevent future aortic events. However, extensive aortic pathology, extensive surgical trauma with prolonged cardiac ischemia, and long duration of cerebral perfusion may combine with individual surgical risk factors to increase early-and longterm mortality in some individuals (15). Other predictors of long-term mortality may be female sex, and a history of atherosclerosis (28), but these factors did not reach statistical significance in WATAS.…”

Section: Other Clinical Predictors Of Late Outcomementioning

confidence: 96%

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Kodolitsch¹,

Wilson²,

Schuler³

et al. 2017

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

Background: Early survivors of acute type A aortic dissection (AAAD) remain at risk for late death and late aortic events. However, the frequency and long-term effects of warfarin anticoagulation on long-term outcome in post-surgical AAAD survivors have not been elucidated. Methods:Two tertiary care centers performed a retrospective observational cohort study of warfarin anticoagulation in AAAD in 243 persons with early survival of surgical repair (WATAS). Serial postoperative tomographic imaging was available in 106 persons.Results: A total of 88 postoperative AAAD survivors (36%) were on long-term warfarin anticoagulation.The indication for anticoagulation was a mechanical aortic prosthesis in 46 (52%), atrial fibrillation in 33 (38%), stroke in 7 (8%), and pulmonary embolism in 1 (1%). The indication for anticoagulation remained unclear in 1 person (1%). Survival and aortic event free survival were 98.3±0.01 and 98.7±0.01 at 1 year, and 76.4±0.03 and 91.8±0.02 at 5 years, respectively, with no differences irrespective of warfarin anticoagulation. Multivariate Cox regression analysis established higher age (P<0.001), and operation extending into the descending aorta (P=0.030) as independent predictors of late death. Follow-up without tomographic imaging independently predicted increased long-term mortality (P<0.001) and lower rates of documented aortic events (P=0.003). Kaplan-Meyer analysis showed a relationship of aortic diameter growth ≥0.5 cm per year with late death (P=0.041) and with late aortic events (P<0.001). However, rapid aortic growth did not relate to warfarin anticoagulation.Conclusions: Warfarin anticoagulation is frequent in postsurgical AAAD and it is administered for vital indications. Warfarin anticoagulation does not relate to late mortality or to late aortic events. Rapid aortic growth predicts late mortality and late aortic events, but warfarin anticoagulation is not associated with aortic growth. Follow-up tomographic imaging is mandatory for long-term survival after surgical repair of AAAD. von Kodolitsch et al. Warfarin in aortic dissection

show abstract

Section: Other Clinical Predictors Of Late Outcomementioning

confidence: 96%

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Kodolitsch¹,

Wilson²,

Schuler³

et al. 2017

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

show abstract

“…FET combines the advantages of conventional ascending aortic and arch surgery with those of endovascular techniques for the descending aorta, thus allowing single-stage treatment of extensive thoracic aortic disease [10,20]. Due to acceptable rates of mortality and morbidity, this technique definitely has been proved to be an advance in aortic surgery and provides an important therapeutic alternative in selected patients [11][12][13].…”

Section: Commentmentioning

confidence: 99%

“…The frozen elephant trunk (FET) technique, which combines conventional surgery with endovascular techniques, allows for a single-stage treatment of such extensive aortic pathologies [10]. Several studies demonstrated the safety and feasibility of the FET procedure with acceptable risk of mortality and morbidity via full sternotomy [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique

Ahmad

Risteski

Papadopoulos

et al. 2016

Eur J Cardiothorac Surg

View full text Add to dashboard Cite

OBJECTIVES: Classically, repair of extensive thoracic aortic pathologies including the aortic arch and descending aorta required two separate major surgical procedures via full sternotomy and a subsequent left lateral thoracotomy. We describe herein our preliminary institutional experience with minimally invasive single-stage extended thoracic aortic replacement employing the frozen elephant trunk (FET) technique via partial upper sternotomy (PUS) in 14 patients. METHODS:Between December 2013 and January 2015, 14 consecutive patients with elective indications for FET underwent minimally invasive FET via PUS (PUS-FET) during moderate systemic hypothermia (28°C) and selective antegrade cerebral perfusion (ACP) using the E-vita Open® hybrid prosthesis ( Jotec GmbH, Hechingen, Germany). The patients' mean age was 66 ± 6 years, and 9 patients (64%) were male. The arch vessels were reimplanted en bloc in all patients. Clinical data were prospectively entered into our institutional database. RESULTS:The surgical procedure was successful in all patients with no need for conversion to full sternotomy. An additional David procedure was performed in 1 patient, whereas 2 patients received a concomitant Bentall procedure. There was no perioperative death or 30-day mortality. The mean cardiopulmonary bypass time was 214 ± 35 min, and the myocardial ischaemic time was 125 ± 14 min. The ACP time was 54 ± 9 min, whereas the ventilation time reached 11 ± 4 h. Intensive care unit stay was 2 ± 3 days. Chest tube drainage within the first 24 h was 460 ± 130 ml. None of the 14 patients required re-exploration for bleeding. Patients were discharged after a hospital length of stay of 9 ± 2 days. No postoperative permanent neurological complication occurred. Two patients (14%) experienced temporary delirium with complete resolution of symptoms prior to discharge from the hospital. CONCLUSIONS: Our preliminary experience suggests that minimally invasive single-stage extended thoracic aortic replacement can safely and reproducibly be performed by employing the concept of PUS-FET.

show abstract

“…In particular the false lumen in the descending aorta thromboses in a large proportion of patients, reducing the risk for further late distal malperfusion syndromes. Several groups have, indeed, published quite satisfactory results with the use of this method, in particular after surgery for acute or chronic aortic dissection (43)(44)(45)(46).…”

Section: The "Frozen Elephant Trunk" Techniquementioning

confidence: 99%

Open repair techniques in the aortic arch are still superior

Bachet¹

2018

Ann. Cardiothorac. Surg.

Self Cite

View full text Add to dashboard Cite

Conventional arch replacement can be carried out in a great majority of patients. Hybrid procedures are often as invasive and technically difficult as conventional ones. Moreover, their immediate results are, in many reported experiences, not better and their long-term results less favourable than the ones observed with conventional methods. So, yes, the open conventional arch replacement is still "the gold standard".

show abstract

Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS

Cited by 275 publications

References 71 publications

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique

Open repair techniques in the aortic arch are still superior

Contact Info

Product

Resources

About