Early Clinical Outcomes of Hybrid Arch Frozen Elephant Trunk Repair With the Thoraflex Hybrid Graft

Chu, Michael; Losenno, Katie L.; Dubois, Luc; Jones, Philip M.; Ouzounian, Maral; Whitlock, Richard; Dagenais, François; Boodhwani, Munir; Bhatnagar, Gopal; Poostizadeh, A.; Pozeg, Zlatko; Moon, Michael; Kiaii, Bob; Peterson, Mark D.

doi:10.1016/j.athoracsur.2018.07.091

Cited by 44 publications

(57 citation statements)

References 20 publications

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“…[4][5][6] Since 2018, Thoraflex Hybrid is our FET device of choice because of the advantages of the branched plexus configuration but LSA anastomosis remains its Achilles heel. 7 To address this, we debranch and selectively cannulate the LSA and LCA with interposition of 10/8 mm Dacron prosthesis avoiding direct cannulation F I G U R E 1 A custom-made Thoraflex Hybrid: (A) cerebral vessels branch (16 mm); (B) perfusion side branch (10 mm) and a Gelweave™ surgical graft: 1, perfusion side branch (10 mm); 2, innominate branch (10 mm); 3, left carotid branch (8 mm); 4, left subclavian branch (8 mm) F I G U R E 2 Homemade perfusion system driven by a single pump: 1, right intrathoracic subclavian artery perfusion (systemic perfusion); 2, left subclavian artery perfusion; 3, left carotid artery perfusion; 4, side branch systemic perfusion and optimizing bilateral cerebral perfusion (always trivascular).…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral non-complete perfusion is minimized and related to the time of LCA anastomosis; HCA and operation times are shortened and probably contribute to a low incidence of major stroke, even in acute dissections (2.3% in acute aortic dissection [1/42]; 1.3%, in all thoraflex implant [1/74], our experience, data pending publication) compared to the literature (5%-14%). 7,8 With this device modification, the vessel lengths are more appropriate and the position of the neo-vessels in the chest avoids malpositioning and/or kinking, and facilitates sternum closure.…”

Section: Discussionmentioning

confidence: 99%

“…The FET technique has rapidly gained acceptance and—despite its complexity—represents the treatment of choice for chronic aortic disease in many centers, 2,3 but its use in acute dissection is still debated 4–6 . Since 2018, Thoraflex Hybrid is our FET device of choice because of the advantages of the branched plexus configuration but LSA anastomosis remains its Achilles heel 7 . To address this, we debranch and selectively cannulate the LSA and LCA with interposition of 10/8 mm Dacron prosthesis avoiding direct cannulation and optimizing bilateral cerebral perfusion (always trivascular).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Reimplantation of the supra-aortic vessels can be challenging with Thoraflex Hybrid. A device modification made the vessel lengths more appropriate and the position of the neo-vessels in the chest avoided malpositioning and kinking and facilitated sternum closure; this may improve operating times as well as allowing complete and continuous cerebral trivascular perfusion and corrects positioning of the intrathoracic vessels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…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.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2021

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Background and Aim of the Study The frozen elephant trunk (FET) procedure became a popular entity for utilization in aortic arch aneurysm disease. However, its proper mortality and morbidities as well as the predictors of outcomes are poorly identified. This systematic review and meta‐analysis explore FET outcomes and its predictors with a focus on zone aortic proximalization. Methods We searched PubMed/MEDLINE, EMBASE, and Scopus databases from their beginning to June 2020 to find studies reporting the outcomes of the FET procedure for the total arch replacement (TAR). Results A total of 64 studies including 7967 patients were evaluated. The pooled estimates of cerebrovascular accidents, paraplegia, renal failure, and in‐hospital mortality were 7.104 (95% confidence interval [CI], 5.691–8.661; I2 = 78.53%), 3.465 (95% CI, 2.852–4.136; I2 = 15.96), 14.969 (95% CI, 11.361–18.977; I2 = 91.26%), and 8.933 (95% CI, 7.128–10.919; I2 = 78.51%), respectively. Stratification by the geographical locations and by the aortic pathologies led to lower heterogeneity, but not for renal failure. The distal anastomosis in Zone 2 was associated with a lower rate of renal failure compared with Zone 3 (odds ratio, 0.54; 95% CI, 0.36–0.81; p = .003; I2 = 0%). Conclusions The FET procedure for TAR can be performed with acceptable mortality and morbidities among patients with complex aortic pathologies. Moreover, the distal anastomosis in Zone 2 was associated with lower renal failure compared to Zone 3.

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“…Delirium was common and experienced by 25% of patients. The median intensive care unit (ICU) length of stay [IQR] was 3 [1,6] days, and the median hospital length of stay [IQR] was 10 [7, 17] days. There was no association between length of FET and SCI (un-adjusted OR: 1.01, 95% CI: 0.99-1.00, P=0.23).…”

Section: Early (In-hospital) Clinical Outcomesmentioning

confidence: 99%

Hybrid arch frozen elephant trunk repair: evidence from the Canadian Thoracic Aortic Collaborative

Ouzounian

Hage

Chung

et al. 2020

Ann Cardiothorac Surg

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Background: The frozen elephant trunk (FET) technique has become an increasingly popular strategy for aortic reconstruction in the setting of extensive thoracic aortic aneurysms or dissections. The objective of this study is to report on the Canadian experience with the FET technique in both the elective and emergent settings. Methods: A total of 167 consecutive patients (mean age 65±13 years, 30% female, 25% re-operation) underwent elective (70%) and non-elective (30%) aortic arch reconstruction with the FET technique between May 2008 and October 2019 in six centers of the Canadian Thoracic Aortic Collaborative (CTAC).In-hospital clinical endpoints and early imaging endpoints were prospectively collected and analyzed.Results: All 167 patients underwent successful FET implantation. In-hospital mortality occurred in 14 patients (8%), stroke occurred in 22 patients (13%) and temporary and permanent spinal cord ischemia (SCI) occurred in 6 (3.6%) and 3 (1.8%) patients, respectively. Prolonged mechanical ventilation was required in 35 patients (21%), renal failure requiring dialysis in 14 patients (8%) and atrial fibrillation in 59 patients (36%). The median hospital and intensive care unit (ICU) lengths of stay were 3 [interquartile range (IQR):1, 6] and 10 (IQR: 7, 17) days, respectively. The rate of type 1A endoleak was 3.6%, with the lowest rate in patients who underwent a total arch replacement with a hybrid FET graft (0%) and the highest among patients who had a hemiarch with antegrade thoracic endovascular aortic repair (TEVAR) deployment (25%).The rate of other types of endoleak and stent complications was comparatively low. Conclusions:The early CTAC experience with the FET operation demonstrates technical feasibility and good early clinical outcomes in elective and emergent patients. Further analysis is required to explore variations in technique and their potential impact on early and late outcomes.

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Early Clinical Outcomes of Hybrid Arch Frozen Elephant Trunk Repair With the Thoraflex Hybrid Graft

Cited by 44 publications

References 20 publications

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

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

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

Hybrid arch frozen elephant trunk repair: evidence from the Canadian Thoracic Aortic Collaborative

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