Technical details making aortic arch replacement a safe procedure using the Thoraflex™ Hybrid prosthesis

Czerny, Martin; Rylski, Bartosz; Kari, Fabian A.; Kreibich, Maximilian; Morlock, Julia; Scheumann, Johannes; Kondov, Stoyan; Südkamp, Michael; Siepe, Matthias; Beyersdorf, Friedhelm

doi:10.1093/ejcts/ezw303

Cited by 44 publications

(25 citation statements)

References 6 publications

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“…Moreover, an LSA anastomosis can be technically challenging due to the extremely deep intrathoracic localization. For this reason, various groups preferred to perform the LSA anastomosis during HCA [ 7 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, even in highly experienced centres, an operative risk remains, in particular with regard to neurological injury both at the central and at the spinal level [ 5 , 6 ]. Consequently, technical and conceptual strategies have been developed to reduce these complications to a minimum, such as proximalization of the descending anastomosis from zone 3 to zone 2 [ 7 ]. In addition, bilateral and on-top trilateral antegrade selective cerebral perfusion have become standard.…”

Section: Introductionmentioning

confidence: 99%

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Taking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study

Grabenwöger

Mach

Mächler

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Our goal was to develop a modified frozen elephant trunk (FET) prosthesis with a stented left subclavian artery (LSA) side branch for LSA connection and to perform preclinical testing in a human cadaver model. METHODS We measured aortic diameters, distance between and diameters of supra-aortic vessels and the distance from the LSA offspring to the level of the left vertebral artery offspring in 70 patients. Based on these measurements, a novel FET prosthesis was developed (Cryolife/Jotec, Hechingen, Germany) featuring a stented side branch for an intrathoracic LSA connection. The feasibility and ease of implantation were tested in 2 human cadaver models at the Anatomical Institute of the Medical University Graz. A covered stent graft (Advanta V12™ by Atrium Medical Corp., Hudson, NH, USA) was used for an LSA extension. RESULTS Accurate deployment of the novel FET prosthesis with anatomical orientation of the stented side branch towards the LSA ostium followed by consecutive stent graft deployment was feasible in both cases. Proximalizing the distal anastomosis level from zone 3 to zone 1 not only diminished the complexity of the procedure but substantially facilitated the completion of the distal anastomosis. A 2.5-cm long extension stent graft was sufficient to seal to the LSA and to maintain left vertebral artery patency in both cases. CONCLUSIONS This initial study in human anatomical bodies could demonstrate the feasibility of implanting a newly designed FET prosthesis. This evolution of the FET technique has the potential to substantially ease total aortic arch replacement by proximalization of the distal anastomosis into zone 1 and by shortening spinal and lower body hypothermic circulatory arrest times via a stented side branch to the LSA. This direct connection enables early restoration of systemic perfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Taking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study

Grabenwöger

Mach

Mächler

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…The detailed operative procedure has been described previously. 6 7 8 9 Briefly, when a target nasopharyngeal temperature of 25°C was achieved, the ascending aorta was clamped and cardioplegia was administered. Concomitant aortic root procedures were performed, if necessary.…”

Section: Methodsmentioning

confidence: 99%

Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections

Almodóvar

Lima

Puga

et al. 2018

Aorta

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Background Acute Type A aortic dissection (AAAD) is a surgical emergency. In patients with arch and descending aorta involvement (DeBakey Type I), a total aortic arch replacement with frozen elephant trunk (FET) could favor false lumen thrombosis and improve long-term results. The authors hereby present their experience with this technique in a single low-volume center, to assess whether the technique is feasible to treat such disease. Methods From January 2011 to December 2016, 43 patients with AAAD were operated on in the authors' institution, which carries out 300 to 350 annual procedures. Among these, 12 patients with an intimal tear in the aortic arch and/or proximal descending aorta received a FET procedure (10 males, age 57 years). Concomitant procedures were aortic valve replacement (42%), Bentall (25%), and aortic valve repair (17%). Results Cardiopulmonary bypass, cardiac arrest, and circulatory arrest times were 235 ± 43, 171 ± 33, and 75 ± 20 minutes, respectively. The operative mortality was 16.7% (n = 2). Stroke and re-thoracotomy for bleeding occurred in 8% (n = 1) and 8% (n = 1), respectively. There was no spinal cord injury. Follow-up was 36.1 months. During follow-up, no patients died or required a reoperation on the downstream aorta. Conclusion Although all patients were operated on in a low-volume center, the results with FET in AAAD are acceptable. Even though this technique demands high technical skills, it is a promising approach in patients with acute aortic dissection.

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“…Furthermore isolation of the LSA is usually performed during the cooling phase, and if the exposure is technically complex, then the circulatory arrest time can be used to gain extra exposure and to reimplant it. 16,17 The branch-first technique has been proposed by different authors trying to reduce the risk of cerebral embolism by disconnecting sequentially the supraaortic vessels and reperfusing them from a single supraaortic vessel. [18][19][20][21][22][23] The known advantage is that the debranching is performed during the cooling period with no extra time added to the procedure.…”

Section: Commentmentioning

confidence: 99%

Preliminary Results of Debranch-First Technique in Frozen Elephant Trunk Procedures

Bertoglio

Fittipaldi

Giambuzzi

et al. 2019

The Annals of Thoracic Surgery

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Background. To evaluate the outcomes of frozen elephant trunk (FET) procedures performed with a customized graft that allows debranch-first technique with continuous antegrade cerebral perfusion and early distal aortic and myocardial reperfusion.Methods. Between 2016 and 2018 34 patients (30 men; median age, 59.7 years) were enrolled in an ambispective single-center study called FET Optimization (clinicaltrials. gov: NCT03600077). The patients underwent FET procedure using a novel modified E-Vita graft (JOTEC GmbH, Hechingen, Germany) plus graft with 2 dedicated reperfusion branches with debranch-first technique. Mortality and morbidity were primary endpoints. Secondary endpoints were overall duration of cardiopulmonary bypass, debranching, limb ischemia, cardiac ischemia, cerebral perfusion, and amount of aortic coverage.Results. No deaths at 30 days were recorded, and the major adverse event (grade ‡ 2) rate was 33% (11 patients) including 1 (3%) nondisabling stroke and 1 (2.9%) permanent spinal cord ischemic event. Proximal FET collar anastomosis were in zone 0 (68%) or zone 1 (32%). Median cardiopulmonary bypass duration was 165 minutes (range, 144-185), distal aortic ischemic time 38 minutes (range, 32-45), and cardiac ischemic time 74 minutes (range, 62-94). The time of distal aortic ischemia was shorter in nonobese patients (27 vs 49 minutes, P [ .043) and in zone 0 (23 cases) vs zone 1 (11 cases) anastomosis (34 vs 42 minutes, P [ .043).Conclusions. The FET procedure with debranch-first technique is safe and feasible and resulted in low mortality and morbidity rates. Further investigation is needed to compare it with standard techniques.

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Technical details making aortic arch replacement a safe procedure using the Thoraflex™ Hybrid prosthesis

Cited by 44 publications

References 6 publications

Taking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study

Taking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study

Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections

Preliminary Results of Debranch-First Technique in Frozen Elephant Trunk Procedures

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