One-stage hybrid aortic repair using the frozen elephant trunk in acute DeBakey type I aortic dissection

Goebel, Nora; Nagib, Ragi; Salehi-Gilani, Schahriar; Ahad, Samir; Albert, Marc; Ursulescu, Adrian; Franke, Ulrich

doi:10.21037/jtd.2018.06.148

Cited by 23 publications

(18 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After reviewing shreds of evidence, a total of 35 studies including 3211 patients were entered into the quantitative analysis (Figure 1). 11–44 The median size of reviewed reports was 72 patients (interquartile range 38 – 122). The majority of studies were performed in Chinese institutions, 19 studies including 2026 patients.…”

Section: Resultsmentioning

confidence: 99%

Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis

Mousavizadeh

Daliri

Aljadayel

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Background The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta‐analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post‐operative neurologic outcomes. Methods A standard Preferred Reporting Items for Systematic Reviews and Meta‐Analyses search was conducted for all observational studies of patients diagnosed with ATAAD undergoing total arch replacement with FET reporting in‐hospital mortality, bleeding, and neurological outcomes. A random‐effect meta‐analysis was performed using STATA software (StataCorp, TX, USA). Results Thirty‐five studies were eligible for the present meta‐analysis, including 3211 patients with ATAAD who underwent total arch replacement with FET. The pooled estimate for in‐hospital mortality, postoperative stroke, and spinal cord injury were 7% (95% CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3% (95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta‐regression revealed that with increasing the duration of hypothermic circulatory arrest time, the effect sizes for postoperative stroke and SCI enhances. Conclusions It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.

show abstract

Section: Resultsmentioning

confidence: 99%

Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis

Mousavizadeh

Daliri

Aljadayel

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…However, recent data do not support the suspected disadvantages and rather show comparable and favorable results. 8 16…”

Section: Discussionmentioning

confidence: 99%

Left Subclavian Artery Sacrifice in Acute Aortic Dissection Repair using the Frozen Elephant Trunk

Goebel

Holder

Huether

et al. 2022

Thorac Cardiovasc Surg

Self Cite

View full text Add to dashboard Cite

Objective Surgery of acute aortic dissection using the frozen elephant trunk (FET) can be complicated when the origin of the left subclavian artery (LSA) is dissected and sacrifice by ligation is a viable option. However, the LSA is supposed to play a role in neuroprotection as a major collateral. We, therefore, analyzed our results of LSA sacrifice in this cohort. Methods We identified a total of 84 patients from our prospectively collected database who underwent FET repair of acute aortic dissection between October 2009 and April 2018. LSA was sacrificed in 19 patients (22.6%). Results were analyzed and compared with regard to neurological outcomes. Results New postoperative stroke was seen in two patients (2.4%) and spinal cord injury in three patients (3.6%) overall, none in the LSA-sacrifice group. We observed a temporary neurological deficit in five patients (6.0%) overall, none in the LSA-sacrifice group. None of the patients developed acute ischemia of the left arm. Only two patients (12.5%) came back for carotid-subclavian artery bypass due to exertion-induced weakness of the left arm 3 to 4 months after the initial surgery. In-hospital mortality was 15.5% overall, with no difference between groups. Conclusion LSA sacrifice was not associated with elevated postoperative risk of either central or spinal neurological injury. Thus, it can facilitate FET repair of acute aortic dissection in selected cases when the left subclavian origin cannot be preserved. Carotid-subclavian artery bypass became necessary in only a small fraction of these patients and can be performed as a second-stage procedure.

show abstract

“…According to the subgroup analysis, the Thoraflex Hybrid graft had the lowest endoleak rates, namely 15 and 19% at the first and last follow-ups, respectively, which were similar to our results. Many surgeons have discussed their concerns regarding the risk of spinal cord injury after implementation of the FET technique (46,47), and most have advocated a higher distal landing zone in all patients and cerebrospinal fluid drainage in high-risk patients. We did not use cerebrospinal fluid drainage in any patient, and the distal landing zone distal to or equal to T8 accounted for 90% of all patients.…”

Section: Discussionmentioning

confidence: 99%

A Novel Sutureless Integrated Stented (SIS) Graft Prosthesis for Type A Aortic Dissection: A Pilot Study for a Prospective, Multicenter Clinical Trial

Dai

Zhao

Cao

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

AimsVarious kinds of surgical strategies and prostheses have been advocated to improve short-term and long-term outcomes in type A aortic dissection (TAAD). Large-scale repair of the pathological aorta is hard to generalize due to complex procedures. We aimed to investigate the performance, effectiveness and safety of a novel Sutureless Integrated Stented (SIS) graft prosthesis in TAAD patients undergoing total arch replacement (TAR) and frozen elephant trunk (FET) implantation surgery.MethodsAll patients admitted to Fuwai Hospital were prospectively screened. Urgent or scheduled surgery was arranged for eligible patients. The primary endpoint was operative mortality. Key secondary endpoints included stroke, spinal cord injury, unexpected aortic reoperation, and 1-year survival. Discharged patients were followed up with computed tomography angiography and transthoracic echocardiography at 3 months, 6 months, and 1 year after surgery. Performance, effectiveness and safety analyses were performed in those patients.ResultsBetween August 1 and September 3, 2020, ten TAAD patients were enrolled in this study and successfully implanted with the SIS graft prosthesis. The median (IQR) age was 56.50 (43.75, 66.75) years (range from 31 to 75), and seven patients were male (70.0%). All patients underwent ascending aorta replacement + TAR + FET and additional procedures when necessary. The median (IQR) operation time, cardiopulmonary bypass time and cross clamp time were 270.50 (218.50, 312.50), 110.00 (88.00, 125.75), 69.50 (51.25, 82.75) min, respectively. Of note, the median (IQR) circulatory arrest time was 9.00 (8.00, 9.00) min (range from 4 to 12). The median (IQR) lowest nasopharyngeal temperature was 26.75 (25.98, 27.67) °C. Follow-up was 100% completed. During the 1-year follow-up, no patients died, no severe adverse events occurred, and rate of freedom from aortic reintervention was 100%.ConclusionsThe SIS graft prosthesis was implanted in a novel sutureless way, which simplified the surgical procedure, shortened the circulatory arrest time and avoided deep hypothermia. The preliminary clinical outcomes and follow-up outcomes demonstrated the effectiveness and safety of this prosthesis. A large-scale trial is being conducted to further assess these findings.

show abstract

One-stage hybrid aortic repair using the frozen elephant trunk in acute DeBakey type I aortic dissection

Abstract: Hybrid aortic repair using the FET in acute DeBakey type I aortic dissection does not elevate the perioperative risk of mortality and provides excellent aortic remodelling with low distal re-intervention rate in mid-term follow-up.

Cited by 23 publications

References 32 publications

Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis

Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis

Left Subclavian Artery Sacrifice in Acute Aortic Dissection Repair using the Frozen Elephant Trunk

A Novel Sutureless Integrated Stented (SIS) Graft Prosthesis for Type A Aortic Dissection: A Pilot Study for a Prospective, Multicenter Clinical Trial

Contact Info

Product

Resources

About