The frozen elephant trunk technique for the treatment of acute complicated Type B aortic dissection

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

doi:10.1093/ejcts/ezx281

Cited by 68 publications

(31 citation statements)

References 18 publications

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“…We compared studies performed only in patients with spinal cord coverage T8 or beyond or 15 cm or greater stent length (n ¼ 6, 201 patients), 15,23,[32][33][34]42 with studies performed only in patients with stent length equal to 10 cm (n ¼ 19, 1634 patients). 15,[17][18][19]21,22,24,25,27,28,33,35,37,[40][41][42]45,46 The patients Figure E1).…”

Section: Subgroup Analysismentioning

confidence: 99%

“…When we compared studies performed only in patients with acute type A aortic dissection (n ¼ 12, 1300 patients) 21,23,25,[27][28][29][30]35,37,41,46,47 with studies performed only in patients with nonacute type A dissection and aneurysm (n ¼ 14, 741 patients), 14,15,17,19,22,[24][25][26]34,40,[42][43][44][45] we found the following results: The pooled mortality rate was 9.2% (95% CI, 6.9-12.4) in the patients with acute type A and 7.6% (95% CI, 4.9-11.4) in the patients with nonacute dissection and aneurysm (P ¼ .46). The pooled rate of stroke in these 2 groups was 9.3% (95% CI, 4.5-18.5) and 6.6% (95% CI, 3.1-13.5) (P ¼ .51), and the pooled rate of SCI was 2.4% (95% CI, 1.3-4.2) and 5.2% (95% CI, 3.1-8.5) (P ¼ .05), respectively ( Figure E2).…”

Section: Acute Type a Versus Nonacute Type A And Aneurysmmentioning

confidence: 99%

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Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Preventza

Liao

Olive

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

166

136

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Objective: The frozen elephant trunk technique's safety regarding spinal cord ischemia has been questioned. We used a meta-analysis to determine the rates of adverse neurologic events and mortality. Methods:We searched PubMed/Medline, Embase, Scopus, and Cochrane databases (inception to April 2018) to identify studies of neurologic events after the frozen elephant trunk procedure. Separate meta-analyses were conducted with random-effects models to assess frozen elephant trunk associations with spinal cord ischemia, stroke, operative mortality, and all adverse events combined. Subgroup analyses compared outcomes in patients with acute versus nonacute type A dissection and aneurysm and with different extents of coverage.Results: Thirty-five studies (total N ¼ 3154) met inclusion criteria. The pooled rates of the outcomes of interest were 4.7% (95% confidence interval, 3.5-6.2) for spinal cord ischemia, 7.6% (95% confidence interval, 5.0-11.5) for stroke, and 8.8% (95% confidence interval, 7.0-10.9) for operative mortality. The spinal cord ischemia event rate was higher with stent length 15 cm or greater or coverage to T8 or beyond than with stent length of 10 cm (11.6% vs 2.5%, P<.001). Adverse event rates in patients with acute type A aortic dissection versus nonacute dissection or aneurysm were as follows: mortality 9.2% versus 7.6% (P ¼ .46), stroke 9.3% versus 6.6% (P ¼ .51), and overall adverse events 22.0% versus 16.5% (P ¼ .41). Conclusions:As the frozen elephant trunk procedure becomes more popular, accurate data regarding outcomes are vital. We associated the frozen elephant trunk technique with (nonsignificantly) more adverse events overall in acute type A dissection cases. Stent length of 10 cm was associated with significantly less risk of spinal cord ischemia. Using a stent 15 cm or greater or coverage extending to T8 or farther should be avoided. (J Thorac Cardiovasc Surg 2020;160:20-33) 35 Studies 3154 Patients 4.7% SCI 7.6% Stroke 8.8% Mortality Extent of SC Coverage Dissection (Type A or DeBakey Type I) / Aneurysm, Nondissection Overall Adverse Event (Mortality / Stroke / SCI) ≥ 15 cm stent length / Coverage at or distal to T8 (6 studies / 201 patients)From the

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Section: Subgroup Analysismentioning

confidence: 99%

Section: Acute Type a Versus Nonacute Type A And Aneurysmmentioning

confidence: 99%

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Preventza

Liao

Olive

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

166

136

View full text Add to dashboard Cite

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“…Some groups have experience using the hybrid arch/FET technique for the treatment of acute complicated type B dissections. [21][22][23] Clearly, TEVAR has transformed the management of acute complicated type B dissections and it has largely supplanted open repair. However, if no proximal landing zone is available, the patient has a moderately dilated arch or the patient has a connective tissue disease and is at elevated risk of retrograde type A dissection, hybrid arch/FET should be considered.…”

Section: Other Indications For Hybrid Arch Repairmentioning

confidence: 99%

The Evolving Role of Hybrid Arch Repair

Chung

Ouzounian

Chu

et al. 2020

Innovations�(Phila)

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“…Consequently, if there are any contraindications or doubts concerning endovascular treatment or coverage of PAU in the distal aortic arch or proximal descending aorta, one should consider total aortic arch replacement using the FET technique. FET has become a well-established option in recent years, especially when additional coronary artery bypass grafting is required (5). In the more distal downstream aorta, open surgical thoracoabdominal replacement can be performed with favorable results in high-volume aortic centers (7).…”

Section: Paumentioning

confidence: 99%