Frozen elephant trunk surgery in acute aortic dissection

Bartolomeo, Roberto Di; Pantaleo, Antonio; Berretta, Paolo; Murana, Giacomo; Castrovinci, Sebastiano; Cefarelli, Mariano; Folesani, Gianluca; Eusanio, Marco Di

doi:10.1016/j.jtcvs.2014.07.098

Cited by 102 publications

(77 citation statements)

References 23 publications

(27 reference statements)

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“…The choice of management was based on the surgeon's preference and most aortic centers advocated a conservative tear-oriented strategy, as the primary objective in this high-risk group of patients has to be the survival of patients and adequate resection of dissected aortic wall (25,26). However, there is a tendency to perform a more extensive total aortic arch replacement with frozen elephant trunk, especially in high-volume aortic centers as the standard treatment with the aim to potentially obliterating the patent false lumen of distal aorta and reducing the risk of aortic dilatation and late aortic re-intervention (4,27,28). Other factors that may push a surgeon to perform a total arch replacement are age, syndromic disease, aneurysm or extensive aortic arch destruction.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Poon

Theologou

Harrington

et al. 2016

Ann. Cardiothorac. Surg.

118

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Background: Despite recent advances in aortic surgery, acute type A aortic dissection remains a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial to achieve satisfactory outcomes but the optimal surgical approach is controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection.Methods: A systematic review of the literature using six databases. Eligible studies include comparative studies on hemiarch versus total arch replacement reporting short, medium and long term outcomes. A meta-analysis was performed on eligible studies reporting outcome of interest to quantify the effects of hemiarch replacement on mortality and morbidity risk compared to total arch replacement. There was no significant difference in terms of in-hospital mortality between the two groups (RR =0.84; 95% CI: 0.65-1.09; P=0.20; I 2 =0%). Cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were significantly longer in total arch replacement. During follow up, no significant difference was reported from current studies between the two operative approaches in terms of aortic re-intervention and freedom from aortic reoperation.Conclusions: Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes are achievable. Conclusions on differences in longer term outcome data are required. We do not, however, advocate total arch as a primary approach by all centers and surgeons irrespective of patient characteristics, but rather, a tailored approach based on surgeon and center experience and patient presentation.

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Section: Discussionmentioning

confidence: 99%

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Poon

Theologou

Harrington

et al. 2016

Ann. Cardiothorac. Surg.

118

View full text Add to dashboard Cite

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“…Evidence has been accumulating that the FET procedure can close the false lumen in the proximal descending aorta and reduce the need for reintervention on the downstream aorta (14)(15)(16)(17)(18)(19)(20). However, the FET technique may fail to achieve false lumen obliteration at the descending thoracic aorta level in 8-15% of patients (21,22). A distal intimal tear after initial surgery for TAAD was a proven risk factor for patent false lumen and dilation of the descending aorta (4).…”

Section: Discussionmentioning

confidence: 99%

Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection

Pan

et al. 2017

J. Thorac. Dis.

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“…The FET technique facilitated singlestage arch and descending Aorta replacement in a complex lesion. Afterwards the indication has been extended to selected patients with AAAD (33).…”

Section: Technique Of Aortic Arch Replacementmentioning

confidence: 99%

When and how to replace the aortic arch for type A dissection

Bartolomeo

Leone

Marco

et al. 2016

Ann. Cardiothorac. Surg.

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Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high.The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD.

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Frozen elephant trunk surgery in acute aortic dissection

Abstract: The FET technique is a promising approach in patients with acute dissection. Solid long-term data are warranted to validate the assumed short- and long-term benefits, but we believe that thoughtful patient selection criteria remain crucial.

Cited by 102 publications

References 23 publications

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection

When and how to replace the aortic arch for type A dissection

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