Total aortic arch replacement with a novel four-branched frozen elephant trunk graft: first-in-man results†

Shrestha, Malakh; Pichlmaier, Maximilian; Martens, Andreas; Hagl, Christian; Khaladj, Nawid; Haverich, Axel

doi:10.1093/ejcts/ezs296

Cited by 109 publications

(70 citation statements)

References 14 publications

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“…In cases of aortic dissection, the stent graft seals descending aortic tears, with expansion of the true lumen and compression of the false lumen, preventing further growth of the proximal descending aorta. 16,18,19,[28][29][30] A major disadvantage of the FET technique seems to be an increased risk of SCI and much higher risk of renal failure compared with the results we describe in our series with the classic ET technique. 31 SCI in FET procedures seems to be multifactorial but likely related to the coverage of the intercostal arteries between T6 and T8.…”

Section: Discussionmentioning

confidence: 91%

“…With this technique, the aortic arch is replaced in a traditional manner and a stented graft is placed in the descending thoracic aorta through the open arch using an antegrade approach. 19,28,29 The landing site should be free from disease to ensure proper anchoring of the stent graft. Subsequently, either open or endovascular procedures can be performed to treat the downstream aorta.…”

Section: Discussionmentioning

confidence: 99%

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The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: Long-term results

Castrovinci

Murana

Maat

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: Long-term results

Castrovinci

Murana

Maat

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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“…The advantages of the use of a novel Thoraflex hybrid graft (Vascutek, Scotland) consisting of a four-branch arch graft with a stent graft at its distal end has been demonstrated (19). It allows for a FET hybrid repair in a single stage operation to complete total arch reconstruction.…”

Section: Hybrid Aortic Arch Replacementmentioning

confidence: 99%

Hybrid repair of aortic arch aneurysms: a comprehensive review

et al. 2017

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Open total arch replacement (TAR) has become safer with refinements in cerebral protection techniques. The frequent extension of aortic arch aneurysms into the descending thoracic aorta customarily requires a two-staged conventional elephant trunk procedure, carrying relatively high mortality and morbidity risks and high rates of rupture in the interval between the two open surgeries. The technical demands and invasive nature of TAR has therefore precluded many high-risk patients from being surgical candidates for aneurysm repair. As a result, hybrid techniques and approaches to the aortic arch have become common since the adoption of thoracic endovascular aortic repair (TEVAR) and advancement in the commercial grafts that are available. The results of hybrid aortic arch repairs have been encouraging, though with higher rates of re-interventions than TAR and variable reported rates of stroke and spinal cord ischemia.The aim of this publication is to review the current literature on hybrid repair of aortic arch aneurysms.

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“…During the early experience with this technique, the prostheses used were basically custom made. Afterwards the first prosthesis that was made commercially available was the E-VITA Jotec Hybrid graft (JOTEC GmbH, Hechingen, Germany) (31), and recently the Thoraflex Hybrid multi-branched graft and distal stent (Vascutek, Renfrewshire, Scotland, UK) (32).…”

Section: Technique Of Aortic Arch Replacementmentioning

confidence: 99%

When and how to replace the aortic arch for type A dissection

Bartolomeo

Leone

Marco

et al. 2016

Ann. Cardiothorac. Surg.

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Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high.The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD.

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Total aortic arch replacement with a novel four-branched frozen elephant trunk graft: first-in-man results†

Cited by 109 publications

References 14 publications

The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: Long-term results

The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: Long-term results

Hybrid repair of aortic arch aneurysms: a comprehensive review

When and how to replace the aortic arch for type A dissection

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