Results of frozen elephant trunk from the international E-vita Open registry

Abstract

Background: Over the years, frozen elephant trunk (FET) has become the treatment of choice for multisegmental thoracic aortic disease. This multicenter study presents the evolution of FET results using the E-vita Open hybrid graft with respect to institutional experience and time. Methods: The data of International E-vita Open registry were studied according to the institutional experience of the participating centers (high-versus low-volume centers) and according to the evolution of FET treatment during time (1 st period, 2005-2011 versus 2 nd period, 2012-2018). Overall, 1,165 patients were enrolled in the study with a wide variety of multisegmental thoracic aortic pathologies and aortic emergencies. Participating centers determined their own surgical protocol. Results: The overall 30-day mortality was 12%. Short-and long-term survival were higher in high-versus low-volume centers (P=0.048 and P=0.013, respectively). In the 2 nd time period, cerebral complications were reduced significantly (P=0.015). Incidence of permanent spinal cord-related symptoms was reduced to 3% in the 2 nd time period, but did not reach statistical significance. Hypothermic circulatory arrest time (P<0.001) and incidence of postoperative temporary renal replacement therapy (P=0.008) were significantly reduced in the 2 nd time period. Ten-year survival and freedom from aortic-related death rates were 46.6% and 85.7%, respectively, for the entire group. The freedom from distal aortic re-interventions for a new or progressive residual aortic disease was 76.0%. Conclusions: Evolution of FET arch repair techniques with the E-vita Open graft and increasing institutional experience were associated with improved results. Progression of residual aortic disease makes close follow-up with aortic imaging mandatory in such patients.

Anatomical variability in the structure of the arch and thoracic aorta and its influence on aorta related pathological conditions

“…По данным M. Shrestha и соавт., у пациентов с хроническим расслоением аорты I типа, подвергшихся реконструкции дуги и нисходящего отдела аорты по типу «замороженный хобот слона», внутригоспитальная летальность и частота развития инсульта составили 4,3 и 10,1 % соответственно [23]. В отдаленном периоде через 3,35 года [1,17] повторным вмешательствам подверглись 36,4 % пациентов. K. Shimamura с соавт.…”

“…Каждая открытая реконструкция дуги аорты сопровождается гипотермическим циркуляторным арестом с использованием анте-или ретроградной перфузии головного мозга. Хотя перфузия головного мозга снижает риск церебральных осложнений, при методике «замороженный хобот слона», по данным международного регистра E-vita Open, частота инсульта составляет 7 % с внутригоспитальной смертностью 15 % [1]. По данным литературы, при применении браншированных стент-графтов для эндопротезирования дуги аорты частота развития инсульта составляет 11,1-16,0 % при 30-дневной летальности 4,5-8,0 % [2][3][4].…”

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

“…It can been delivered anterogradely form the arch by an introducer and the vascular portion is invaginated inside the stent graft, after the suture fixation the incorporate arch prosthesis is released from the endovascular portion and used to replace the arch, in case of the Evita open the tubular graft allows the reimplantation of the supra-aortic vessel 'en block'. The Evita Open stent graft portion is available between 20 and 40 mm ant the SG length is available 130, 150 and 160 mm [4].…”

“…In the recent report of the E-vita Open international registry accounting for 1165 patients the overall in-hospital mortality rate was 12% and permanent cerebral and spinal cord complications occurred in 5.2% and 3.9% respectively [4].…”

“…The outcomes are very excellent considering the magnitude of the procedure, even do, morbidities remain substantial. The rate of paraplegia ranges from zero to 5%, the risk of developing post-operative renal insufficiency from 3 to 10% and the risk of stroke from 3% to 8% [1,4,14,20].…”