Management of the difficult left subclavian artery during aortic arch repair

Hage, Ali; Ginty, Olivia K.; Power, Adam; Dubois, Luc; Dagenais, François; Appoo, Jehangir J.; Bozinovski, John; Chu, Michael

doi:10.21037/acs.2018.03.14

Cited by 27 publications

(21 citation statements)

References 22 publications

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“…It was simply designed too close to the arch collar, hence making it very challenging to sew the subclavian limb directly to the subclavian vessel after performing the arch collar anastomosis. The decision about how to handle the left subclavian artery largely depended on the patient's anatomy on preoperative CT and urgency status [21]. If the subclavian artery was anticipated to be difficult reach and the patient was elective, then either a preoperative left carotid-subclavian bypass or transposition was performed.…”

Section: Commentmentioning

confidence: 99%

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

Chu

Losenno

Dubois

et al. 2019

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

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

Chu

Losenno

Dubois

et al. 2019

The Annals of Thoracic Surgery

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“…[4][5][6][7] However, this approach is fraught with technical challenges, as the LSA can be deep and thus challenging, and various approaches and decision algorithms have been described. [6][7][8] The 3 approaches to LSA anastomosis described here allow better planning for full restoration of the supra-aortic branches, including the anticipated approach to achieve proximal control for anastomosis with good hemostasis in our experience. The 20-mm…”

Section: Discussionmentioning

confidence: 97%

Management of left subclavian artery in total arch replacement and frozen elephant trunk procedure

Bashir

Jakob

et al. 2021

JTCVS Techniques

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Video clip is available online.The advent of frozen elephant trunk (FET) revolutionized open surgical management of total aortic arch aneurysm disease. 1,2 However, one of the challenges is the left subclavian artery (LSA) anastomosis, which is often deep and difficult to visualize. The emerging use of E-vita OPEN NEO (JOTEC, Hechingen, Germany) is a promising approach to tackling this challenge. We report our early experience and describe the advantages of its design in facilitating anastomosis of the LSA.The new arch branched graft E-vita OPEN NEO was introduced to our center in October 2020. Between October and November 2020, 3 patients underwent total arch replacement using FET with the branched version of E-vita OPEN NEO. The operations were elective, the pathology was type III aortic dissection with arch aneurysm, and none had undergone previous aortic surgery. Perioperative data were collected retrospectively from institutional database with the patients' informed consent (Table 1). Mean operative time and circulatory arrest time were 315 AE 79 minutes and 47 AE 2 minutes, respectively.

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“…The head vessels were either re-implanted onto the individual hybrid graft branches or sewn prior to circulatory arrest using a bi-or trifurcated graft. Several variations were employed for dealing with the left subclavian artery, which have previously been described (5). Systemic reperfusion was restored via a side-limb or cannula in the arch graft.…”

Section: Surgical Techniquementioning

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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Management of the difficult left subclavian artery during aortic arch repair

Cited by 27 publications

References 22 publications

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

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

Management of left subclavian artery in total arch replacement and frozen elephant trunk procedure

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

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