Long-term results of the frozen elephant trunk technique for extended aortic arch disease

Uchida, Naoshige; Katayama, Akira; Tamura, Kentaro; Miwa, Soichi; Kuraoka, Masatsugu; Murao, Naoki; Ishiguro, Hiroshi

doi:10.1016/j.ejcts.2010.01.007

Cited by 49 publications

(35 citation statements)

References 18 publications

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“…The supraaortic vessels may be anastomosed end-to-end to side branches of the graft or as a patch. [6][7][8][9][10][11][12][13] Unfortunately, some delivery systems are quite cumbersome and deployment of the stented portion of the graft might be imprecise, therefore causing a far more distal landing than intended.…”

Section: Introductionmentioning

confidence: 99%

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

et al. 2016

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Aim: To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Methods and results: Between January 2001 and December 2012, 34 patients (mean age 59.9 AE 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 AE 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid-and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. Conclusions: In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up.

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Section: Introductionmentioning

confidence: 99%

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

et al. 2016

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“…3 4 These numbers hold up even in patients undergoing surgery for type A dissection, redo procedures, and extended arch repair. 3 5 Patel and coworkers identified independent predictors of early mortality like advanced age, prolonged bypass times, and impaired ejection fraction in open surgery. 3 Together with independent predictors of late mortality, such as prolonged lower body circulatory arrest times and increasing creatinine values, these variables might help in selecting patients better suited for endoluminal repair.…”

Section: Discussionmentioning

confidence: 99%

A Rare Complication of TEVAR Performed for Complex Acute Stanford B Aortic Dissection

Awad

Zardo

Baraki

et al. 2017

THORAC CARDIOV SURG Reports

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“…3) For our patient, we performed total arch replacement using the FET technique for resecting the intimal flap to optimally widen the true lumen and to improve abdominal organ ischemia, with excellent aortic remodeling. 6) We also considered the conventional elephant trunk technique. However, to make the true lumen as long as possible, the FET technique would be better than the conventional elephant trunk technique.…”

Section: Discussionmentioning

confidence: 99%

Peripartum Type A Aortic Dissection Repair Using Frozen Elephant Trunk Technique

Iida

Ito²,

Inaba³

et al. 2016

Annals of Vascular Diseases

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A 43-year-old woman with abdominal and back pain during childbirth consulted us 1 day postdelivery. Contrastenhanced computed tomography (CT) revealed partially thrombosed type A aortic dissection with intimal tear in the proximal descending thoracic aorta. Conservative antihypertensive treatment was started. However, her abdominal pain progressively deteriorated. Repeat CT revealed narrowing of the descending aorta true lumen and progressive bowel malperfusion. Total arch replacement was urgently performed using the frozen elephant trunk technique. Postoperative CT showed true lumen widening and symptom disappearance. Follow-up CT demonstrated excellent aortic remodeling. Keywords: peripartum aortic dissection, pregnancy, aortic remodeling Case ReportA 43-year-old woman under hypertension medication consulted us for sudden postpartum upper abdominal and back pain. She delivered a baby girl 7 days ago and since then felt refractory continuous upper abdominal and back pain. On admission, her height was 157 cm and her weight was 68 kg, without any Marfan syndrome or Loeys-Dietz syndrome features. Her blood pressure was 182/92 mmHg, with no difference in both arms. Chest X-ray showed mediastinal enlargement.Contrast-enhanced computed tomography (CT) showed type A aortic dissection. The primary entry tear was in the proximal site of the distal arch (Fig. 1A). The descending aorta true lumen was compressed by the false lumen owing to the large entry in the distal arch (Fig. 1B). Conservative antihypertensive treatment was started because of the thin and thrombosed ascending aorta false lumen. The patient's blood pressure decreased to 122/56 mmHg. However, her abdominal pain progressively deteriorated. Repeat CT revealed narrowing of the descending aorta true lumen (Fig. 2A); visceral malperfusion worsening was anticipated (Fig. 2B).Considering the progressive risk of visceral malperfusion, the patient underwent urgent operation. To resect the primary entry tear and enlarge the true lumen distally as extensively as possible, we performed total arch replacement using the FET technique. Following median sternotomy, cardiopulmonary bypass (CPB) was established. Under circulatory arrest (CA) with selective cerebral perfusion (SCP) at a rectal temperature of 25°C, the ascending aorta was opened. There was an intimal tear in the proximal descending aorta. The proximal descending aorta was constituted to obliterate the false lumen. For the FET technique, a 26-mm-diameter stent graft (J Graft open stent graft, Junken Medical Co., Ltd., Chiba, Japan) was introduced and deployed antegradely into the descending aorta true lumen. The integrated Dacron graft was pulled out and sutured with the orifice of the previously constituted descending aorta. Three arch vessels were reconstructed using a tetrafurcated 24-mm-diameter woven Dacron graft (J Graft Shield Neo, Junken Medical Co.,

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Long-term results of the frozen elephant trunk technique for extended aortic arch disease

Abstract: The frozen elephant technique could be an attractive treatment for extended aortic arch disease to the extended descending aorta for acute aortic dissection as well as arteriosclerotic aneurysm.

Cited by 49 publications

References 18 publications

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

A Rare Complication of TEVAR Performed for Complex Acute Stanford B Aortic Dissection

Peripartum Type A Aortic Dissection Repair Using Frozen Elephant Trunk Technique

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