Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?☆

Kretzler, Matthias; Kamiya, Hiroyuki

doi:10.1016/j.ejcts.2008.02.030

Cited by 80 publications

(45 citation statements)

References 58 publications

(107 reference statements)

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“…Inhospital mortality seems to be improved in comparison to the conventional ET (6.4% vs 10.2%, respectively) [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. In a recent review published in 2008, FET has even been considered the standard treatment for extended aortic aneurysm as an alternative to conventional ET, as it allows for one-stage repair of combined aortic arch and proximal descending aortic aneurysm [60].…”

Section: Fet Techniquementioning

confidence: 97%

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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The treatment of complex aortic pathology involving both the ascending and descending aortic segments at the same time represents a surgical challenge, with high postoperative morbidity and mortality rates reported. Over the past 27 years, different open surgical and endovascular techniques have been introduced and applied in various two-stage- or one-stage approaches to such cases. Thus, in 1983, Hans Borst significantly changed the traditional two-stage approach by introducing his elephant trunk technique. Leaving a segment of Dacron prosthesis reaching into the descending aorta during the first stage, the second-stage replacement of the residual dilated descending aorta was made far easier. The presence of interval mortality between the two stages, the unaffected need for two large operations to complete aortic repair, and the general failure of some patients to return for the second-stage repair set the scene for the development of one-stage procedures, both open surgical or hybrid surgical and endovascular, such as the frozen elephant trunk. However, the size of the operation, on the one hand, and the risk of spinal cord injury and need for surgical or endovascular completion during follow-up, on the other, have dampened enthusiasm. Recently, the introduction of supra-aortic debranching and endovascular aortic arch stent-graft repair has yet extended treatment to high-risk patients unsuitable to the more aggressive surgery, but mid- and long-term follow-up results are lacking. The lack of randomization and the presence of procedural and complication-related limitations for each technique do not allow for definitive conclusions about the ideal procedure to treat complex aortic pathology. However, the technical revolution experienced over the past 27 years, along with the improvement in perioperative management, has produced outstanding morbidity and mortality results even in this challenging patient population, but the decision regarding which pathology correlates with what operation remains highly debated and dependent also on regional competence.

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Section: Fet Techniquementioning

confidence: 97%

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…No cases of spinal cord ischemia have occurred in our patients since we began to use the blood-return procedure, but additional research on the pathogenesis of paraplegia after OSG is required. Karck and Kamiya,12) in a review of use of the frozen elephant trunk technique in 215 patients in eight series, reported a perioperative mortality rate of 7% (15 patients, including patients with acute aortic dissection). The overall perioperative mortality rate in our series was similar (6%), although the rate among our 44 patients who had elective surgery was lower (4%).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Open Stent-Grafting Using a Matsui-Kitamura Stent to Treat Thoracic Aortic Aneurysm

Midorikawa

Kanno

Takano

et al. 2015

ATCS

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Purpose: We describe a retrospective study of initial and long-term outcomes with an open stent grafting (OSG) with a Matsui-Kitamura stent for treating thoracic aortic aneurysm. Methods: Between August 2005 and September 2013, 50 patients with aortic arch disease extending to the descending aorta underwent OSG. Circulatory arrest with total cardiopulmonary bypass and selective cerebral perfusion were used, and the aorta was transected between the brachiocephalic and left subclavian artery. The stent-graft was inserted, sutured to a transected aortic edge, and anastomosed to a four-branched arch graft. Preoperative, operative, and short-and long-term postoperative data were obtained from the patients' medical records. Results: The perioperative (within 30 days) mortality rate was 8%. Two patients (4%) had a stroke and 5 patients (10%) had a spinal cord injury resulting in paraplegia or paraparesis (1 patient each) or transient paraplegia (3 patients). Actuarial survival rates at 1, 3, 5, and 7 years postoperatively were 87.8%, 78.3%, 70.7%, and 65.3%, respectively; the rates of freedom from an aortic event were 100%, 89.1%, 82.2%, and 74.7%. There were no complications related to use of the stent-graft. Conclusion: Our OSG method provided durable results in patients treated for thoracic aortic aneurysm, with few adverse events.

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“…Abb. 5; [22]), um das perfundierte falsche Lumen möglichst langstreckig zu beseitigen [54,23]. Dies bedeutet jedoch für den einzelnen AADA-Patienten einen primär komplexeren operativen Eingriff mit einer längeren Herz-Kreislauf-Stillstandszeit sowie einer längeren myokardialen Ischämiezeit, verbunden mit einem erhöhten perioperativen Risiko.…”

Section: Operative Strategie Bei Aada Mit Aortenbogenbeteiligungunclassified

Deutsches Register für akute Aortendissektion Typ A (GERAADA)

Conzelmann

Krüger

Hoffmann

et al. 2011

Herz

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A European Registry of Aortic Diseases ("EuRADa") is being established this year under the leadership of the "Vascular Domain" of the European Association for Cardio-Thoracic Surgery (EACTS). This database will collect parameters on all aortic diseases, dissection types A and B, aneurysms, perforating ulcer (PAU), intramural wall hematoma (IMH), traumatic aortic ruptures, and all potential treatment strategies (medical treatment, open surgical and endovascular).

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Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?☆

Cited by 80 publications

References 58 publications

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Long-Term Results of Open Stent-Grafting Using a Matsui-Kitamura Stent to Treat Thoracic Aortic Aneurysm

Deutsches Register für akute Aortendissektion Typ A (GERAADA)

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