The elephant trunk is freezing: The Hannover experience

Shrestha, Malakh; Beckmann, Erik; Krueger, Heike; Fleißner, Felix; Kaufeld, Tim; Koigeldiyev, Nurbol; Umminger, Julia; Ius, F.; Haverich, Axel; Martens, Andreas

doi:10.1016/j.jtcvs.2015.01.044

Cited by 104 publications

(74 citation statements)

References 17 publications

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“…The literature search identified 1,268 records, of which nine satisfied the inclusion criteria and definitions for hybrid versus traditional aortic arch surgery (6,7,(18)(19)(20)(28)(29)(30)(31) (study details in Table S1). Two studies were identified as high quality, three as intermediate quality and four as standard quality using the adapted scoring criteria.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Concomitant procedures were reported for both CTAR and HAR patients across six of nine studies (6,7,20,28,30,31). Operative data for individual included studies is detailed in Table S3.…”

Section: Resultsmentioning

confidence: 99%

“…Attenuation of overall effect due to broad definitions was evident when examining particular meta-analytic outcomes for our included studies. For example, for early mortality, those hybrid cohorts with a large (or total) proportion of debranch procedures (6,7,18,19) had RRs closer to unity than for hybrid cohorts consisting of predominantly FET patients (28,30,31). Differences in intra-operative factors such as usage of cardiopulmonary bypass usage for hybrid procedures (7) or concomitant procedures potentially also lead to heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

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Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Chakos¹,

Jbara²,

Yan³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: Surgical interventions for aortic aneurysm and dissection remain associated with high risk of mortality and morbidity. Advances in operative techniques have led to a variety of options for the cardiac surgeon, including endovascular and hybrid approaches. Debate remains over which of these techniques provide optimal outcomes for the patient. The present systematic review and meta-analysis aims to evaluate long term patient survival and identify short-term outcomes for conventional (open) aortic arch repair and hybrid aortic arch repair (HAR).Methods: An electronic literature search was conducted according to predefined inclusion criteria for hybrid and conventional aortic arch repair surgery. Digitized survival data was extracted from identified studies' Kaplan-Meier curves and used to re-create individual patient data for aggregated survival analysis.Post-operative morbidity and mortality were analyzed using random-effects model meta-analysis.Results: Nine studies were included, containing 841 hybrid arch repair and 1,182 conventional arch repair patients. Pooled Kaplan-Meier analysis of all patients demonstrated higher survival in hybrid arch repair patients than conventional arch repair patients, however, this was noted to be sensitive to results from a particular study. Overall results showed for the hybrid repair cohort, survival at 1, 2, 3, 5 and 7 years was 87%, 85%, 83%, 78% and 75%, respectively. Survival in the conventional repair cohort at 1, 2, 3, 5 and 7 years was 84%, 82%, 80%, 75% and 71%, respectively. Statistically significant findings from meta-analysis showed hybrid arch repair was associated with lower risk of re-operation for bleeding, while conventional arch repair was associated with reduced risk of spinal cord injury.Conclusions: Pooled Kaplan-Meier analysis of all studies showed long-term survival outcomes for hybrid and conventional aortic arch repair patients are heterogeneous and sensitive to the results of particular studies. Superior results from particular centres and the low number of comparative studies mean that more data is required to make definitive findings with regards to the long-term survival outcomes of either procedure. Hybrid arch repair was associated with lower risk of re-operation for bleeding, while conventional arch repair was associated with lower risk of spinal cord injury. Surgeons should consider their own center's experience and patient suitability when deciding between hybrid or conventional aortic repair techniques.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Concomitant procedures were reported for both CTAR and HAR patients across six of nine studies (6,7,20,28,30,31). Operative data for individual included studies is detailed in Table S3.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Chakos¹,

Jbara²,

Yan³

et al. 2018

Ann. Cardiothorac. Surg.

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“…Some surgeons use an endoscope to evaluate a distal landing zone during hypothermic circulatory arrest. 5) The use of an endoscope is effective for confirming the complete sealing of an aortic lesion by a stent graft after implantation. However, an endoscope cannot confirm the relationship between the thoracic aorta and vertebrae.…”

Section: Discussionmentioning

confidence: 99%

Radiopaque Ruler-Guided Frozen Elephant Trunk Technique

Ikeda

Konishi

Matsuzaki

et al. 2016

Annals of Vascular Diseases

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Frozen elephant trunk (FET) technique combines open surgery and endovascular repair for extensive thoracic aortic aneurysms. When a FET is inserted into the descending thoracic aorta, it is difficult to confirm its proper positioning. Here we report a radiopaque ruler-guided FET technique. On the basis of preoperative computed tomography, we create a roadmap which shows the relationship between the descending thoracic aorta and vertebrae. During surgery, a radiopaque ruler placed beneath the patient's back provides the accurate target position under fluoroscopy. Our technique is effective to prevent spinal cord injury because it avoids an overly deep implantation of a FET. Keywords: thoracic aortic aneurysm, open surgery, endovascular repair TechniqueA 73-year old male, who had a distal arch aneurysm with a maximal diameter of 55 mm, underwent a total arch replacement using the FET technique. Based on preoperative computed tomography (CT), we created a road map which showed the relationship between the thoracic aorta and vertebrae (Fig. 1). We decided the target position of a FET according to following criteria: i) the distal landing zone is >20 mm and ii) FET is never inserted over T7. If an implantation of a FET over T7 is needed to secure an adequate landing zone, we consider that the FET technique is contraindicated. In this patient, the target position was set at the lower border of T6.Before starting surgery, a radiopaque ruler (LeMaitre Stent Guide 270 mm, LeMaitre Vascular, Burlington, MA) was placed beneath the left side of the patient's back, and then we confirmed the graduation of the ruler which indicated the target position under fluoroscopy. Prophylactic cerebrospinal drainage was not routinely performed.After exposure of the left axillary artery using an infraclavicular approach, a median sternotomy was performed. The left pleural cavity was opened, and a hole was bored in the 2nd intercostal space. Thus, an extra-anatomical bypass route from the mediastinum to the left axillary artery was created. After systemic heparinization, cardiopulmonary bypass was established by cannulation of the ascending aorta and right atrium. While systemic cooling, an 8-mm Triplex vascular prosthesis (Terumo, Tokyo, Japan) was anastomosed to the left axillary artery.Circulatory arrest was induced at a rectal temperature of 25°C. After clamping the ascending aorta, cold crystalloid cardioplegia was administered through the aortic root cannula. Selective cerebral perfusion was initiated using balloon catheters cannulated into the brachiocephalic and left common carotid artery. The left subclavian artery was ligated and perfused using the 8-mm graft which was anastomosed to the left axillary artery. The aortic arch was transected between the brachiocephalic and left common carotid artery. The orifice of the left common carotid artery was stumped. A 33 × 90 mm J Graft Open Stent (Japan Lifeline, Tokyo, Japan) was inserted into the descending thoracic aorta and deployed at the target

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