Abstract:ObjectiveReport initial experience with the Frozen Elephant Trunk technique.MethodsFrom July 2009 to October 2013, Frozen Elephant Trunk technique was performed
in 21 patients (66% male, mean age 56 ±11 years). They had type A
aortic dissection (acute 9.6%, chronic 57.3%), type B (14.3%, all chronic)
and complex aneurysms (19%). It was 9.5% of reoperations and 38% of
associated procedures (25.3% miocardial revascularization, 25.3% replacement
of aortic valve and 49.4% aortic valved graft). Aortic remodeling wa… Show more
“…Dias et al, when publishing the initial experience of the group, emphasized that not only the severity of the underlying disease, the percentage of reoperations and the high number of associated procedures but also the learning curve could influence the results of the procedure.…”
Section: Discussionmentioning
confidence: 99%
“…Thus, our results confirmed that the need for reintervention is due to the characteristics of the primary disease, and not because of the failure of FET's prosthesis. Besides, FET simplified reintervention in the distal segments, providing a more appropriate landing zone for endovascular completion …”
Section: Discussionmentioning
confidence: 99%
“…Thus, our results confirmed that the need for reintervention is due to the characteristics of the primary disease, and not because of the failure of FET's prosthesis. Besides, FET simplified reintervention in the distal segments, providing a more appropriate landing zone for endovascular completion 8,13,14. Interestingly, the application of the FET procedure has significantly increased over recent years, including acute aortic dissection.In this context, a strong argument favoring the FET procedure includes complex arch tears and distal aortic malperfusion.…”
Objective
The purpose of this study was to analyze the learning curve effect on hospital mortality, postoperative outcomes, freedom from reintervention in the aorta and long‐term survival after frozen elephant trunk (FET) operation.
Methods
From July 2009 to June 2018, 79 patients underwent surgery with the FET technique. They had type A aortic dissection (acute 7.6%, chronic 33%), type B aortic dissection (acute 1.26%, chronic 34.2%), and complex thoracic aortic aneurysm (24%). 27.8% were reoperations and 43% received concomitant cardiac procedures. To compare the results, the sample was divided into group 1 (G1) (first half of the sample ‐ operations from 2009 to 2014) and group 2 (G2) (first half of the sample ‐ operations from 2015 to 2018).
Results
The in‐hospital mortality was 20.25%, 30.7% for G1 and 10% for G2 (P = .02). The mean cardiopulmonary bypass time, myocardial ischemia time, and selective cerebral perfusion at 25°C time were 154 ± 31, 118 ± 32, and 59 ± 12 minutes, respectively, similar for both groups. Stroke and spinal cord injury occurred in four and two patients, with no difference between groups (P = .61 and P = .24). The necessity for secondary intervention on the downstream aorta for both groups was also similar (P = .136). Five of sixty‐three surviving patients died during the follow‐up period and the estimated survival rate was different between groups 49% vs 88% (P = .007).
Conclusion
The learning curve with the FET procedure had a significant impact on hospital mortality and midterm survival over the follow‐up period, albeit did not influence the freedom from reintervention on the downstream aorta.
“…Dias et al, when publishing the initial experience of the group, emphasized that not only the severity of the underlying disease, the percentage of reoperations and the high number of associated procedures but also the learning curve could influence the results of the procedure.…”
Section: Discussionmentioning
confidence: 99%
“…Thus, our results confirmed that the need for reintervention is due to the characteristics of the primary disease, and not because of the failure of FET's prosthesis. Besides, FET simplified reintervention in the distal segments, providing a more appropriate landing zone for endovascular completion …”
Section: Discussionmentioning
confidence: 99%
“…Thus, our results confirmed that the need for reintervention is due to the characteristics of the primary disease, and not because of the failure of FET's prosthesis. Besides, FET simplified reintervention in the distal segments, providing a more appropriate landing zone for endovascular completion 8,13,14. Interestingly, the application of the FET procedure has significantly increased over recent years, including acute aortic dissection.In this context, a strong argument favoring the FET procedure includes complex arch tears and distal aortic malperfusion.…”
Objective
The purpose of this study was to analyze the learning curve effect on hospital mortality, postoperative outcomes, freedom from reintervention in the aorta and long‐term survival after frozen elephant trunk (FET) operation.
Methods
From July 2009 to June 2018, 79 patients underwent surgery with the FET technique. They had type A aortic dissection (acute 7.6%, chronic 33%), type B aortic dissection (acute 1.26%, chronic 34.2%), and complex thoracic aortic aneurysm (24%). 27.8% were reoperations and 43% received concomitant cardiac procedures. To compare the results, the sample was divided into group 1 (G1) (first half of the sample ‐ operations from 2009 to 2014) and group 2 (G2) (first half of the sample ‐ operations from 2015 to 2018).
Results
The in‐hospital mortality was 20.25%, 30.7% for G1 and 10% for G2 (P = .02). The mean cardiopulmonary bypass time, myocardial ischemia time, and selective cerebral perfusion at 25°C time were 154 ± 31, 118 ± 32, and 59 ± 12 minutes, respectively, similar for both groups. Stroke and spinal cord injury occurred in four and two patients, with no difference between groups (P = .61 and P = .24). The necessity for secondary intervention on the downstream aorta for both groups was also similar (P = .136). Five of sixty‐three surviving patients died during the follow‐up period and the estimated survival rate was different between groups 49% vs 88% (P = .007).
Conclusion
The learning curve with the FET procedure had a significant impact on hospital mortality and midterm survival over the follow‐up period, albeit did not influence the freedom from reintervention on the downstream aorta.
“…With our in situ stent graft fenestration technique, anastomosis of the LSA was simplified, and the circulatory arrest time was shorter in our study than in the study by Dias et al (23.28 6 5.56 minutes vs 40 6 8 minutes). 15 In addition, the results of cerebral complication were encouraging as only five (4.7%) patients had transient neurologic dysfunction, and no permanent neurologic dysfunction occurred.…”
The in situ graft fenestration technique could simplify the procedure of LSA reconstruction during total arch replacement, provide a good surgical view for anastomosis and hemostasis, shorten the operation time, and yield satisfactory early and midterm results. It is a safe and effective alternative approach for suitable patients with AAAD. However, the long-term results of this technique need further evaluation.
“…We have read the interesting article entitled "Surgical treatment of complex aneurysms and thoracic aortic dissections with the Frozen Elephant Trunk technique" carefully [ 1 ] . The authors report their initial experience with this technique in 21 patients.…”
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