Experience with the conventional and frozen elephant trunk techniques: a single-centre study

Leontyev, Sergey; Borger, Michael A.; Etz, Christian D.; Moz, Monica; Seeburger, Joerg; Bakhtiary, Farhard; Misfeld, Martín; Mohr, Friedrich W.

doi:10.1093/ejcts/ezt252

Cited by 114 publications

(96 citation statements)

References 22 publications

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“…The literature search identified 1,268 records, of which nine satisfied the inclusion criteria and definitions for hybrid versus traditional aortic arch surgery (6,7,(18)(19)(20)(28)(29)(30)(31) (study details in Table S1). Two studies were identified as high quality, three as intermediate quality and four as standard quality using the adapted scoring criteria.…”

Section: Resultsmentioning

confidence: 99%

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Chakos¹,

Jbara²,

Yan³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: Surgical interventions for aortic aneurysm and dissection remain associated with high risk of mortality and morbidity. Advances in operative techniques have led to a variety of options for the cardiac surgeon, including endovascular and hybrid approaches. Debate remains over which of these techniques provide optimal outcomes for the patient. The present systematic review and meta-analysis aims to evaluate long term patient survival and identify short-term outcomes for conventional (open) aortic arch repair and hybrid aortic arch repair (HAR).Methods: An electronic literature search was conducted according to predefined inclusion criteria for hybrid and conventional aortic arch repair surgery. Digitized survival data was extracted from identified studies' Kaplan-Meier curves and used to re-create individual patient data for aggregated survival analysis.Post-operative morbidity and mortality were analyzed using random-effects model meta-analysis.Results: Nine studies were included, containing 841 hybrid arch repair and 1,182 conventional arch repair patients. Pooled Kaplan-Meier analysis of all patients demonstrated higher survival in hybrid arch repair patients than conventional arch repair patients, however, this was noted to be sensitive to results from a particular study. Overall results showed for the hybrid repair cohort, survival at 1, 2, 3, 5 and 7 years was 87%, 85%, 83%, 78% and 75%, respectively. Survival in the conventional repair cohort at 1, 2, 3, 5 and 7 years was 84%, 82%, 80%, 75% and 71%, respectively. Statistically significant findings from meta-analysis showed hybrid arch repair was associated with lower risk of re-operation for bleeding, while conventional arch repair was associated with reduced risk of spinal cord injury.Conclusions: Pooled Kaplan-Meier analysis of all studies showed long-term survival outcomes for hybrid and conventional aortic arch repair patients are heterogeneous and sensitive to the results of particular studies. Superior results from particular centres and the low number of comparative studies mean that more data is required to make definitive findings with regards to the long-term survival outcomes of either procedure. Hybrid arch repair was associated with lower risk of re-operation for bleeding, while conventional arch repair was associated with lower risk of spinal cord injury. Surgeons should consider their own center's experience and patient suitability when deciding between hybrid or conventional aortic repair techniques.

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Section: Resultsmentioning

confidence: 99%

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Chakos¹,

Jbara²,

Yan³

et al. 2018

Ann. Cardiothorac. Surg.

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“…Furthermore, a hybrid total arch and frozen elephant trunk procedure has consistently been reported to incur a greater risk of spinal cord ischemia. 21 Therefore, the invasive nature of surgery does add non-negligible risks particularly to those with premorbid risk factors. Consequently, opting for the medical therapy-first strategy in patients who may benefit by an initial conservative approach should be further investigated through larger studies.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Acute Retrograde Type A Aortic Dissection With an Entry Tear in Descending Aorta

et al. 2014

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Background-Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined. Methods and Results-Of the 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 men; 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable with thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) on an intentionto-treat basis. In the MED group, 1 patient was converted to urgent aortic surgery and 2 patients underwent endovascular stent grafting in the descending aorta during the initial hospitalization. The early (30-day or in-hospital) mortality rates were 0% and 9.1% in the MED and SURG group, respectively (P=0.54).

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“…Utilization of cerebrospinal fluid drainage, adjusting the distal landing zone above the level of T7, keeping the anterograde perfusion time short, paying attention to the continuity of left subclavian artery are the precautions that can be taken for spinal cord protection. However, in spite of the protection methods of spinal cord, percentages of paraplegia as 21.7 and 24 14,20 stated in the literature are demoralizing, the presence of successful series stated as 8% and 9% 13,21 is encouraging.…”

Section: -13mentioning

confidence: 95%

“…Mortality varied between 3.8% and 17.2% in conducted studies using FET technique without grouping complex aortic diseases. 8,10,14,15,16 When the complex thoracic aortic diseases were arranged into groups, especially in type I aortic dissection, Pochettino and coworkers 9 stated the conditions requiring emergency cardiac surgery as an independent risk factor for mortality and it was reported that mortality percentage was 13.9 for first 30 days. Likewise, as known, acute type I aortic dissection with mortality percentage varying between 7.8 and 18.2 in the literature was observed to be a predictive factor on mortality independently of operation.…”

Section: -13mentioning

confidence: 99%

Early period results for repair of complex thoracic aortic diseases with E-vita open stent graft

Akbulut¹,

Arslan²,

Ak³

2017

ejcm

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Aim: Nowadays, usage of hybrid techniques in complex aortic diseases, especially in the high risk patient group for conventional surgery, enables us to cope with the challenges posed in major surgery and reduce complications. In this study, we evaluate our early results in patients who underwent Frozen Elephant Trunk procedure using e-Vita Open stent grafts for complex aortic disease.Methodology: A total of 61 patients (mean age 56 ±11.5, 50 patients (81.9%) were male) who underwent E-vita Open Plus repair between January 2013 and October 201, with the diagnosis of either acute / chronic type I aortic dissection, acute / chronic type III aortic dissection, or thoracic aortic aneurysm were analyzed retrospectively. 21 patients (34.4%) had acute / chronic type I aortic dissection, 22 (36.0%) had acute / chronic type III aortic dissection, 11 (18.0%) had thoracic aortic aneurysm and 7 (11.4%) had residual type I aortic dissection.Results: Arterial cannulation sites were right subclavian artery in 57 patients (93.4%), brachiocephalic artery in 2 patients (3.2%) and ascending aorta in 2 patients (3.2%). The mean times for antegrade cerebral perfusion and cardiopulmonary bypass were 80 minutes (range 52-167) and 178 minutes (range 105-350) respectively. First 30-day mortality rate was 7 (11.4%). In terms of neurological deficit, 2 patients (3.2%) had paraplegia, 3 (4.9%) had major stroke/coma and one (1.6%) had right hemiplegia. Patients with paraplegia and hemiplegia recovered completely and were free of any neurological deficits during discharge. Conclusion:Frozen elephant trunk procedure is a good alternative method which makes the techniques of surgical repair more feasible in the treatment of complex aortic diseases and enables us to use the combination of surgery and endovascular techniques to reduce complications.Key words: Aortic dissection, complex repair, frozen elephant trunk, early results Abstract

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Experience with the conventional and frozen elephant trunk techniques: a single-centre study

Cited by 114 publications

References 22 publications

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Outcomes of Acute Retrograde Type A Aortic Dissection With an Entry Tear in Descending Aorta

Early period results for repair of complex thoracic aortic diseases with E-vita open stent graft

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