Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting (original) (raw)
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European Journal of Cardio-Thoracic Surgery, 2011
Objective: The purpose of this study was to examine our experience with the frozen elephant trunk in patients with chronic aortic dissection. Methods: In our Institution, between January 2007 and August 2010, 49 patients (mean age: 59.6 AE 9.0 years) underwent total arch replacement with the frozen elephant trunk technique for chronic aortic dissection (type A, n = 2; residual type A, n = 37; type B, n = 10). Forty patients (81.6%) patients had undergone previous cardiovascular procedures. Associated cardiac procedures were indicated in 21 (42.8%) patients. Brain protection was achieved with antegrade selective cerebral perfusion in all cases. Results: Hospital mortality (n = 5) was 10.2%. Postoperative serious complications included coma (n = 3; 6.1%), paraplegia (n = 2; 4.1%), respiratory failure (n = 6; 12.2%), and definitive dialysis (n = 2; 4.1%). Follow-up was 100% completed (mean period: 12.9 AE 11.7 months). The estimated 1-and 3-year survival rates were 91.2 AE 4.2% and 81.6 AE 6.5%, respectively. Endovascular extension was required in 11 (22.4%) patients, with technical success of 100%. Complete thrombosis of the peri-stent false lumen was achieved in 82.9% of cases, with significant reduction of the false lumen diameter (preoperative: 36 AE 11 mm; postoperative: 24 AE 17 mm; p = 0.001) and increase of the true lumen diameter (preoperative: 15 AE 5 mm; postoperative: 26 AE 6 mm; p = 0.001). Conclusions: The frozen elephant trunk technique, allowing treatment of extensive disease of the thoracic aorta, was associated with encouraging short-and midterm results. Longer-term follow-up is warranted.
Frozen elephant trunk surgery in type B aortic dissection
Annals of cardiothoracic surgery, 2014
ABSTRACT Objectives Acute aortic dissection is a catastrophic condition, for which emergent surgery represents mainstay of therapy. Approximately 70% of patients who survive surgery remain with a dissected distal aorta that poses them at risk of late aneurysmal degeneration, rupture, malperfusion and that often mandates secondary extensive interventions. Methods In order to improve long-term prognosis, a more extensive intervention named ‘Frozen Elephant Trunk (FET)’ has been introduced. This involves the simultaneous replacement of the aortic arch and antegrade stenting of the descending thoracic aorta (DTA). While FET, by inducing both coverage of secondary entry tears located in the proximal DTA and obliteration of the false lumen at the proximal DTA, is assumed to produce total thoracic aortic remodeling, its role in acute dissection patients remains controversial mostly due to its augmented technical complexity and increased risk of paraplegia. Results Data available in literature show that, after FET interventions, hospital death, stroke and spinal cord injury occur in 10.0%, 4.8%, 4.3% of acute dissection patients, respectively. Available long-term data are sparse but suggest that aortic remodeling with partial or complete thrombosis of the persistent false lumen can be expected in approximately 90% of cases. Conclusions The FET technique is a promising approach in acute dissection patients. While solid long-term data are warranted to validate assumed short- and long-term benefits, we believe thoughtful patient selection criteria remain crucial.
Repair of residual aortic dissections with frozen elephant trunk technique
The Turkish Journal of Thoracic and Cardiovascular Surgery
Background: In this study, we present our mid-term results of reoperation with the frozen elephant trunk procedure due to patent false lumen-related complications in patients previously undergoing supracoronary aortic repair for acute type A aortic dissection. Methods: Between January 2013 and September 2018, a total of 23 patients (17 males, 6 females; mean age 51.5±9.7 years; range, 30 to 67 years) who underwent ascending aortic replacement due to type A aortic dissection and, later, frozen elephant trunk procedure for residual distal dissection were included. For diagnostic purposes and follow-up, computed tomography angiography was performed in all patients, and both re-entry and aortic diameters were evaluated. Echocardiography was used to evaluate cardiac function and valve pathologies. Results: The Ishimaru zone 0 (n=11, 47.8%), Ishimaru zone 1 (n=1, 4.3%), Ishimaru zone 2 (n=4, 17.4%), and Ishimaru zone 3 (n=7, 30.4%) were used for frozen elephant trunk stent graft fixation....
PRILOZI, 2020
Aneurysms of the thoracic aorta involving the distal arch and the proximal descending aorta have traditionally been treated with two open procedures. During the first stage, the aortic arch pathology has been addressed through a median sternotomy. Several weeks or months later, a second stage followed and included completing the repair of the descending aorta through a lateral thoracotomy. We, herein, report a single stage repair of an aneurysm involving the distal aortic arch and the proximal descending aorta using the frozen elephant trunk operative technique. Vascular hybrid stent graft prosthesis, specifically designed for treatment of extensive aortic aneurysms, has been used to replace the arch component and exclude the descending aorta component of the aneurysm through a median sternotomy, using bilateral antegrade cerebral perfusion and mild systemic hypothermia for intraoperative organ protection.
Frozen elephant trunk surgery in acute aortic dissection
The Journal of Thoracic and Cardiovascular Surgery, 2014
Acute aortic dissection is a catastrophic condition, for which emergency surgery is the mainstay of therapy. In approximately 70% of patients who survive surgery, a dissected distal aorta remains, posing a risk of late aneurysmal degeneration, rupture, and malperfusion, and secondary extensive interventions are often required. In order to improve the long-term prognosis, a more extensive intervention, the frozen elephant trunk (FET) procedure, has been introduced. This involves the simultaneous replacement of the aortic arch and antegrade stenting of the descending thoracic aorta (DTA). Although FET is assumed to produce total thoracic aortic remodeling by inducing both coverage of secondary entry tears located in the proximal DTA and obliteration of the false lumen at the proximal DTA, its role in patients with acute dissection remains controversial mostly because of its technical complexity and increased risk of paraplegia. Data available in literature show that, after FET interventions, hospital death, stroke, and spinal cord injury occur in 10.0%, 4.8%, and 4.3% of patients with acute dissection, respectively. Available long-term data are sparse but suggest that aortic remodeling with partial or complete thrombosis of the persistent false lumen can be expected in approximately 90% of cases. The FET technique is a promising approach in patients with acute dissection. Solid long-term data are warranted to validate the assumed short- and long-term benefits, but we believe that thoughtful patient selection criteria remain crucial.
Complex thoracic aortic disease: Single-stage procedure with the frozen elephant trunk technique
The Journal of Thoracic and Cardiovascular Surgery, 2010
Objective: Extensive thoracic aortic aneurysms represent a challenging pathology in cardiac surgery. The frozen elephant trunk procedure, combining conventional surgery with endovascular techniques, allows single-stage treatment for such pathology. Here we present our surgical technique and results with the single-stage frozen elephant trunk procedure. Methods: Between January 2007 and December 2009, 67 patients were treated with the frozen elephant trunk procedure in our institution. Mean age was 61 AE 11 years. Indications for surgery included chronic aneurysm (n ¼ 22, 32.8%), acute type A dissection (n ¼ 4, 6.0%), acute type B dissection (n ¼ 2, 3.0%), chronic type A dissection (n ¼ 30, 44.8%), and chronic type B dissection (n ¼ 9, 13.4%). Thirty-six patients (53.7%) had undergone 38 previous cardiac or aortic operations. Thirty-two associated aortic and cardiac operations were performed. Brain protection was achieved by means of antegrade selective cerebral perfusion and moderate hypothermia (26 C) in all cases. Results: In-hospital mortality was 13.4%. Postoperatively, permanent neurologic dysfunction (coma) occurred in 5 cases (7.5%), paraplegia in 2 (3.2%), and paraparesis in 3 (4.9%). Follow-up was 100% complete, with mean duration of 11.1 AE 8.4 months. The 1-and 2-year survivals were 76.7 AE 5.6% and 70.3 AE 8.0%, respectively. Ten patients (14.9%) required endovascular completion 2.3 AE 3.1 months after the first procedure, with 100% technical and procedural success. Conclusions: In contrast to the conventional elephant trunk technique, the frozen elephant trunk technique offers a potentially curative single-stage procedure for patients with extensive thoracic aortic disease, with encouraging short-term and midterm results.
The Annals of Thoracic Surgery, 2011
OBJECTIVES: Providing effective treatment for complicated type B aortic dissection (AD) with concomitant pathologies of the aortic arch or ascending aorta is challenging, especially if the aortic anatomy is contraindicated for thoracic endovascular aortic repair (TEVAR). We present the early results of a multicentre study using the frozen elephant trunk (FET) technique for type B AD. , data from 465 patients who had undergone treatment with the FET technique were collected in the database of the International E-vita Open Registry. From this cohort, 57 patients who had a primary indication for surgery for type B AD were included in the present study. Their mean age was 58 ± 12 years, and 72% had a chronic dissection. All operations were performed in circulatory arrest and bilateral antegrade cerebral perfusion. Computed aortic imaging was performed for false lumen (FL) evaluation during the follow-up.
Usefulness of frozen elephant trunk technique for distal aortic arch aneurysms
Vessel Plus, 2020
Aim: The effectual use of frozen elephant trunk (FET) has been for total aortic arch replacement (TAR) of acute aortic dissection because of positive aortic remodeling. However, the use of FET in the non-dissecting aortic arch aneurysm is still contr oversial. We aim to investigate the outcomes of TAR using the FET technique for distal aortic arch aneurysms. Methods: Between August 2014 and February 2020, 40 patients (35 males, mean age 77.0 years) underwent TAR by using the FET technique with the J Graft Open Stent Graft for distal aortic arch aneurysms including 8 patients with shaggy aorta. In 5 of 40 patients, coronary bypass grafting was concomitantly performed. We followed up for 29.0 months. Results: The mortality were 0%. Stroke occurred in three patients (7.5%) one of whom had shaggy aorta, paraparesis in one patient (2.5%) who recovered fully, and respiratory complication in two patients (5.0%). There was no recurrent nerve palsy. During the follow-up period, death had no relationship with aortic disease. Conclusion: We conclude the FET has the potential to improve TAR for distal aortic arch aneurysms.