“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

Choudhury, Rafaat; Basharat, Kamran; Zahra, Syeda Anum; Tran, Tien; Rimmer, Lara; Harky, Amer; Idhrees, Mohammed; Bashir, Mohamad

doi:10.1177/15385744211002493

Cited by 16 publications

(53 citation statements)

References 37 publications

(80 reference statements)

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“…Though surgical techniques for both approaches vary between centres and devices, the procedure can be summarised as involving four main phases: initiation, aortotomy, prosthesis implantation, and rewarming. 5 Techniques for Zone 2 FET arch repair are widely documented and are broadly similar to Zone 3 arch repair (Figure 1). 5,13,14 In contrast, arch repair can be achieved via two main approaches in Zone 0 FET, depending on the prosthetic device employed.…”

Section: Zone 2 Vs Zone 0: Surgical Techniquementioning

confidence: 99%

“…5 Techniques for Zone 2 FET arch repair are widely documented and are broadly similar to Zone 3 arch repair (Figure 1). 5,13,14 In contrast, arch repair can be achieved via two main approaches in Zone 0 FET, depending on the prosthetic device employed. These are examined below.…”

Section: Zone 2 Vs Zone 0: Surgical Techniquementioning

confidence: 99%

“…5 TAR with FET is currently indicated for repairing aneurysms of the aortic arch and DTA, as well as acute, chronic, and residual Type A aortic dissection. 5 When faced with a Type A aortic dissection, the aortic surgeon is presented with the option to proceed either a conservative or aggressive therapeutic approach. 6,7 Whereas the former advocates the use of an initial hemiarch repair (HAR) before taking further steps to address the sequalae of Type A aortic dissection, the latter recommends a TAR with deployment of an FET to control intimal tears and stimulate false lumen (FL) remodelling.…”

Section: Introductionmentioning

confidence: 99%

“…3 Although use of the FET is advantageous over cET as it involves only one surgery and is associated with fewer complications and a lower re-intervention rate, it remains a technically demanding intervention. 5 The complications associated with FET are especially debilitating -spinal cord injury, cerebral injury, and kidney failure are cited as occurring in up to 11%, 26%, and 22% of cases respectively. 11,12 Notably, the aortic zone at which the elephant trunk stent is anastomosed to the aortic arch graft is a key issue of debate.…”

Section: Introductionmentioning

confidence: 99%

“…However, in recent decades, this technique has given way to distal anastomosis at Zone 2 (Z-2-FET) -which is now the preferred surgical approach as it is associated with even better clinical outcomes than Z-3-FET. 5 Following this paradigm shift, surgeons have began questioning whether proximalising FET implantation to Zone 0 (Z-0-FET) would further improve surgical operability and clinical outcomes. 1 This begs the question: is proximalisation of aortic repair from Zone 2 to Zone 0 simply a concept, or true challenge?…”

Section: Introductionmentioning

confidence: 99%

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Aortic Proximalisation -- Zone 0 vs. Zone 2. A Concept or True Challenge?

Tan

Lopuszko

Munir

et al. 2021

Preprint

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Background Use of the Frozen Elephant Trunk (FET) device to manage complex surgical pathologies of the aorta (e.g. acute Type A aortic dissection) has gained popularity since its introduction in the early 2000s. Though the distal anastomosis was traditionally performed at Zone 3 (Z-3-FET), preference gradually shifted towards Zone 2 (Z-2-FET) in favour of improved surgical access and outcomes. This review seeks to elucidate whether proximalisation of arch repair to Zone 0 (Z-0-FET) would further improve postoperative outcomes. Methods We performed a review of available literature to evaluate the comparative efficacies of Z-2-FET versus Z-0-FET, in terms of surgical technique, clinical outcomes, and incidence of adverse events. Results Z-0-FET seems to be associated with a more accessible surgical approach, and shorter cardiopulmonary bypass, antegrade cerebral perfusion, and cardioplegia durations than Z-2-FET. Further, Z-0-FET is could potentially be associated with a lower incidence of neurological, renal, and recurrent laryngeal nerve injury, as well as mortality and reintervention rates than Z-2-FET. This said, Z-0-FET is itself associated with significant challenges, and efficacy in terms of postoperative true lumen integrity and false lumen thrombosis is mixed. Conclusion Current literature seems to suggest that Z-0-FET procedures are more straightforward and associated with lower rates of certain adverse events, however, the majority of data reviewed is retrospective. This review therefore recommends prospective research into the comparative strengths and limitations of Z-0-FET and Z-2-FET to better substantiate whether proximalisation of arch repair represents a concept, or a true challenge to advance surgical intervention for arch pathologies.

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Section: Zone 2 Vs Zone 0: Surgical Techniquementioning

confidence: 99%

Section: Zone 2 Vs Zone 0: Surgical Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aortic Proximalisation -- Zone 0 vs. Zone 2. A Concept or True Challenge?

Tan

Lopuszko

Munir

et al. 2021

Preprint

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Staging TEVAR after FET — an exception or the rule?

Di Marco,

Nocera,

Snaidero

et al. 2023

Indian J Thorac Cardiovasc Surg

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Purpose Frozen elephant trunk (FET) was born as an ideal one-step procedure to treat complex arch and descending thoracic aorta pathology. It was then proved that it frequently needs reintervention, which can often be performed by thoracic endovascular aortic repair (TEVAR) extension since FET provides a safe proximal landing zone. We hereby describe our experience in TEVAR extension after FET, its main indications, technique, and outcomes. Methods Between 2007 and 2022, 371 patients underwent FET at our center. Of these, 119 needed TEVAR extension. Some required more than one TEVAR, with a total of 154 procedures. The preoperative characteristics, indications, and outcomes were analyzed retrospectively. Results Of 154 TEVAR procedures, 15 were performed in an urgent setting. Mean time from FET to TEVAR was 22,2 ± 28,73 months. Two patients died in the operating room; no others died during the hospital stay. Survival after 1, 2, 5, and 10 years was 96.2%, 93.9%, 90.1%, and 70.5% respectively. There was no statistically significant difference in the rates of TEVAR extension for patients in which a Thoraflex™ vs E-vita™ graft was used, nor for zone 2 vs zone 3 anastomosis and stent length. Conclusion Though TEVAR extension is often required after FET, it is a safe and effective procedure with excellent post-operative outcomes in the short-, mid-, and long-term and allows successful treatment of complex aortic pathologies. Rigorous and specialized follow-up after FET is central to identify the right moment to intervene.

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Frozen Elephant Trunk Sizing: A 30,000-Feet Perspective with Thoraflex Hybrid Stent Graft

Tan

Idhrees²,

Bashir

2022

Aorta (Stamford)

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There is currently no standard, evidence-based approach for sizing the Thoraflex Hybrid prosthesis in frozen elephant trunk surgery. We present regional data on 906 Thoraflex grafts implanted in the United Kingdom between December 2012 and August 2021 to emphasize the heterogeneity in sizing practices and evaluate the impact this may have on clinical outcomes. Highlighting this heterogeneity will help develop an evidence-based approach to prosthesis sizing, thereby aiding decision-making for arch repair.

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“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

Cited by 16 publications

References 37 publications

Aortic Proximalisation -- Zone 0 vs. Zone 2. A Concept or True Challenge?

Aortic Proximalisation -- Zone 0 vs. Zone 2. A Concept or True Challenge?

Staging TEVAR after FET — an exception or the rule?

Frozen Elephant Trunk Sizing: A 30,000-Feet Perspective with Thoraflex Hybrid Stent Graft

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