Thoracic Endovascular Repair after Total Aortic Arch Replacement with Frozen Elephant Trunk for Type a Aortic Dissection

Fortin, William; Gautier, Charles-Henri; Escande, Remi; Bel, Alain; Sutter, Willy; El Batti, Salma; Julia, Pierre; Achouh, Paul; Alsac, Jean-Marc

doi:10.1016/j.avsg.2023.08.026

Cited by 2 publications

(2 citation statements)

References 24 publications

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“…In a recent study by Kreibich et al, 15 patients (23%) required additional aortic interventions within 12 months of TEVAR [21]. Other authors have suggested the enhancement of TEVAR with candy-plug embolisation of the false lumen or application of the PETTICOAT or STABILISE techniques to achieve a favourable remodelling of the entire aorta in the midterm [16,18,24]. We successfully performed a distal completion with a fenestrated stent-graft in three patients and an open repair of the infrarenal abdominal aorta in six further patients.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, open surgical repair of the descending aorta after FET with anastomosis to the stent-graft portion used to be applied; however, it had considerable mortality and morbidity rates [10,14,16,17]. Therefore, the concept of an endovascular distal extension through thoracic endovascular aortic repair (TEVAR), which was first suggested by Uchida et al in 2013, has been adopted in several centres worldwide [16,[18][19][20][21][22][23][24][25]. The aim of this retrospective study was to evaluate the results of complementary TEVAR following the FET procedure in patients with residual type A aortic dissection (rTAAD) in terms of its technical feasibility, safety and mid-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Complementary Thoracic Endovascular Aortic Repair (TEVAR) after Frozen Elephant Trunk for Residual Type A Aortic Dissection: Perioperative and Mid-Term Outcomes

Mylonas,

Mammadov,

Dorweiler

2024

JCM

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Objectives: The aim of this retrospective study was to evaluate the results of complementary TEVAR following the frozen elephant trunk (FET) procedure for patients with residual type A aortic dissection (rTAAD) in terms of technical feasibility, safety and mid-term outcomes. Methods: This was a retrospective single-centre analysis of patients who received TEVAR after FET for rTAAD from January 2012 up to December 2021. The primary endpoint was technical success. Safety parameters included 30-day/in-hospital morbidity and mortality. Furthermore, mid-term clinical and morphological outcomes were evaluated. Results: Among 587 TEVAR procedures, 60 patients (11 with connective tissue disorders) who received TEVAR after FET for rTAAD were identified. The median interval between FET and TEVAR was 28.5 months. Indications for TEVAR after FET were true lumen collapse distal to FET prosthesis (n = 7), dSINE (n = 2), planned completion (n = 13) and aortic diameter progression (n = 38). In forty-seven patients, TEVAR was performed in an elective setting; eight and six patients were operated on in an urgent or emergency setting, respectively. All TEVAR procedures were successfully completed. The 30-day mortality and spinal cord ischemia rates were 1.7%. During a median follow-up of 37 months, two further patients died. Nine patients had to undergo a further aortic intervention: fenestrated stent-graft (n = 3) or open repair of the infrarenal abdominal aorta (n = 6). Conclusions: Complementary TEVAR following FET for rTAAD showed excellent technical success and low perioperative risk, supporting the feasibility and safety of this strategy. Despite the favourable mid-term survival, certain patients might require a further aortic procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complementary Thoracic Endovascular Aortic Repair (TEVAR) after Frozen Elephant Trunk for Residual Type A Aortic Dissection: Perioperative and Mid-Term Outcomes

Mylonas,

Mammadov,

Dorweiler

2024

JCM

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Surgical Strategies in Reoperation of the Proximal Aorta and Arch for Patients with Previous Frozen Elephant Trunk

Arjomandi Rad,

Ansaripour,

Magouliotis

et al. 2024

JCM

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Background: The frozen elephant trunk (FET) technique is increasingly utilized for aortic arch replacement in cases of aortic dissections and aneurysms. This rise in usage has led to more patients needing redo aortic surgeries due to progression of existing conditions, FET-related complications, or new valvular/coronary diseases. This article aims to evaluate surgical techniques to minimize risks during these reoperations, including a case study of a complex redo surgery. Methods: A comprehensive examination of surgical strategies was conducted, focusing on preoperative preparation, cannulation site identification, cerebral and cardiac protective measures, and pitfalls to avoid. The importance of adapting to the modified anatomical landscape post-FET is emphasized. A detailed case study of a patient undergoing complex redo FET surgery is included. Results: The article identified key surgical strategies for reoperation in patients with prior FET, highlighting the importance of meticulous preoperative planning and execution. Techniques to minimize risks include detailed imaging for planning, strategic cannulation for optimal perfusion, multidisciplinary approaches as well as careful fail-safe measures. The case study demonstrates the practical application of these strategies in a high-risk scenario. The evidence underscores the necessity for individualized patient management and the development of standardized protocols. Conclusions: The FET technique, while effective for initial aortic arch repairs, often necessitates complex reoperations. Adopting advanced surgical strategies and multidisciplinary planning can significantly mitigate risks associated with these procedures. Future research should focus on refining these techniques and establishing standardized protocols to improve patient outcomes.

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Thoracic Endovascular Repair after Total Aortic Arch Replacement with Frozen Elephant Trunk for Type a Aortic Dissection

Cited by 2 publications

References 24 publications

Complementary Thoracic Endovascular Aortic Repair (TEVAR) after Frozen Elephant Trunk for Residual Type A Aortic Dissection: Perioperative and Mid-Term Outcomes

Complementary Thoracic Endovascular Aortic Repair (TEVAR) after Frozen Elephant Trunk for Residual Type A Aortic Dissection: Perioperative and Mid-Term Outcomes

Surgical Strategies in Reoperation of the Proximal Aorta and Arch for Patients with Previous Frozen Elephant Trunk

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