Frozen Elephant Trunk for Acute Type B Dissection Involving the Distal Arch in the Hybrid Repair Era

Qi, Rui-Dong; Zhu, Jun; Liu, Yongmin; Chen, Lei; Li, Cheng-Nan; Xing, Xiao-Yan; Zhang, Nan; Sun, Lu

doi:10.1016/j.athoracsur.2018.04.011

Cited by 9 publications

(11 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Okita et al [18] reported an hospital mortality rate of 2.4% with an incidence of spinal cord injury of 3.5% with the Frozenix device. Similar results were reported in other studies from Japan [19], China [20] and Canada [21]. In Bologna, between 2007 and 2021, 343 patients underwent aortic surgery with Frozen Elephant Trunk.…”

Section: Review Of the Literature And Bologna Experience In Different Aortic Pathologiessupporting

confidence: 88%

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

et al. 2021

View full text Add to dashboard Cite

The frozen elephant trunk technique (FET) requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft component, which is placed into the proximal descending thoracic aorta (DTA) anterogradely in the proximal descending thoracic aorta. In Europe, two hybrid prostheses are available: the E-evita Open Plus hybrid stent graft system provided by JOTEC (Hechingen, Germany) and the ThoraflexTM Hybrid (Vascutek, Inchinnan Scotland). Recommendations for use are extensive pathologies of the arch in case of acute and chronic aortic dissection, degenerative aneurysm and intramural hematoma. The FET approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally. The remarkable feature of this technique is the possibility to perform more proximally (from zone 3 to zone 0) the distal anastomosis in to the arch. This allows for an easier distal anastomosis, reduced hypothermic circulatory arrest time and decreased risk of paraplegia (<5%). Early results are promising and according to the most recent series the rate of developing post-operative renal insufficiency ranges from 3 to 10%, the risk of stroke from 3% to 8% and mortality from 8–15%. The aim of the article will be to provide some knowledge about the use and application of FET procedures in different aortic situations.

show abstract

Section: Review Of the Literature And Bologna Experience In Different Aortic Pathologiessupporting

confidence: 88%

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

et al. 2021

View full text Add to dashboard Cite

show abstract

“…However, if the pathology involves the distal aortic arch, open surgery would be the first consideration in our center. LAA‐LCCA transposition or hemi‐arch replacement with stented elephant trunk implantation under hypothermic cardiopulmonary bypass with selective antegrade cerebral perfusion has been demonstrated to obtain satisfactory outcomes in our center 4,5 …”

Section: Discussionmentioning

confidence: 91%

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

et al. 2021

View full text Add to dashboard Cite

Background This study aimed to evaluate the clinical outcomes of one‐staged hybrid procedure for aortic lesions involving the distal aortic arch. Methods We retrospectively studied 99 consecutive patients who underwent the hybrid procedure (thoracic endovascular aortic repair combined with supra‐arch branch vessel bypass) in our center between April 2009 and January 2020 for lesions involving the distal aortic arch. Results Median age was 64.0 (57.0–69.0) years, and 83 (83.8%) patients were male. There were five deaths in the perioperative period (three due to cerebral infarction and two due to intimal rupture). During the median follow‐up of 41.0 months, 20 patients died, three had endoleak, one had a newly formed intimal tear, and two had femoral artery pseudoaneurysm. The 5‐ and 10‐year survival rates of the total population were 72.2% and 48.8%, respectively. Additionally, there was no difference in the 5‐year survival rate among the four groups according to different pathologies (Type B aortic dissection, aortic ulcer, aortic aneurysm, aortic pseudoaneurysm: 74.7%, 78.2%, 61.1%, and 75.5%, respectively, p = .58). Furthermore, there was no difference in the 5‐ and 10‐year survival rates between the two groups according to the different bypass methods (right axillary artery [RAA]‐left axillary artery [LAA] vs. RAA‐LAA‐left common carotid artery: 74.1% vs. 68.9%, p = .38). Conclusions Although one‐staged hybrid procedure has fewer complications in high‐risk patients with lesions involving the distal aortic arch, the long‐term survival rate is not optimistic.

show abstract

“…Recently, frozen elephant trunk implantation has revolutionized the surgical strategy used for TAAD and TBAD repair. 13 , 14 For example, the distal anastomosis site is shallower with use of this technique; therefore, performing the anastomosis is easier and safer. We used a frozen elephant trunk in a patient with complicated TBAD.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Arakawa¹,

Okamura²,

Miyagawa³

et al. 2020

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Background Decision-making regarding the operability of thoracic aortic disease in nonagenarian patients remains controversial because outcomes of open surgical repair of the thoracic aorta are unclear. We investigated the surgical and nonsurgical outcomes of acute thoracic aortic syndrome treatment in nonagenarians. Methods After evaluating data in our institute from April 2016 to March 2020, we included 10 nonagenarians who needed surgical intervention on the thoracic aorta via a median sternotomy for acute thoracic aortic syndrome. The mean age of the cohort was 91.9 ± 2.1 years. Five patients underwent open surgical repair of the thoracic aorta (surgical group), and 5 refused surgery (nonsurgical group). All patients in the surgical group performed activities of daily living independently, with a mean clinical frailty scale of 3.2 ± 0.4. The surgical group included 4 patients with type A aortic dissection and one with a ruptured thoracic aortic aneurysm. Hemiarch replacement was performed in 3 patients and total arch replacement in 2. The mean follow-up period was 17.8 ± 5.1 months. Results Hospital mortality rates were 0% in the surgical and 80% in the nonsurgical group. The mean length of hospitalization was 28.4 ± 6.7 days in the surgical group. The 1-year survival rates were 100% in the surgical group and 20% in the nonsurgical group. Conclusion Open surgical repair for acute thoracic aortic syndrome via median sternotomy is a reasonable treatment option even in nonagenarians. Involvement of family members is important for decision-making to devise the optimal treatment strategy (surgical vs. medical).

show abstract

Frozen Elephant Trunk for Acute Type B Dissection Involving the Distal Arch in the Hybrid Repair Era

Cited by 9 publications

References 29 publications

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Contact Info

Product

Resources

About