Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases

TY - JOUR

T1 - Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases

AU - Detter, Christian

AU - Demal, Till Joscha

AU - Bax, Lennart

AU - Tsilimparis, Nikolaos

AU - Kölbel, Tilo

AU - von Kodolitsch, Yskert

AU - Vettorazzi, Eik

AU - Reichenspurner, Hermann

AU - Brickwedel, Jens

N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

PY - 2019/4/8

Y1 - 2019/4/8

N2 - OBJECTIVES: This study aims to analyse the impact of a simplified frozen elephant trunk (FET) technique on early outcome.METHODS: Between October 2010 and August 2018, 92 consecutive patients (mean age 64.4 ± 12.2 years) underwent FET surgery. Underlying pathologies were thoracic aneurysm in 35 patients, acute aortic dissection in 25 patients and chronic dissection in 32 patients. Thirty patients underwent a simplified FET technique with deployment of the stent graft in arch zone 2 with an extra-anatomic bypass to the distal left subclavian artery using the third branch of the Thoraflex™ Hybrid Plexus prosthesis via a supraclavicular access during reperfusion. These patients were compared to 62 patients who received the conventional FET procedure, in which a distal anastomosis is performed in arch zone 3.RESULTS: Circulatory arrest (41.7 ± 10.5 vs 76.5 ± 33.0 min; P < 0.001) and antegrade cerebral perfusion times (60.9 ± 13.5 vs 92.1 ± 33.1 min; P < 0.001) were significantly reduced in zone 2 vs zone 3 patients, respectively. The 30-day mortality rate was 3.3% (n = 1) in zone 2 patients vs 17.7% (n = 11) in zone 3 patients (P = 0.75). Stent deployment in zone 2 was associated with significantly reduced rates of postoperative stroke [zone 2: n = 0 (0.0%); zone 3: n = 11 (17.7%), P = 0.046] and recurrent nerve palsy [zone 2: n = 1 (3.3%); zone 3: n = 14 (22.6%), P = 0.020).CONCLUSIONS: Simplifying the FET procedure leads to reduced circulatory arrest and cerebral perfusion times and improves early outcome.

AB - OBJECTIVES: This study aims to analyse the impact of a simplified frozen elephant trunk (FET) technique on early outcome.METHODS: Between October 2010 and August 2018, 92 consecutive patients (mean age 64.4 ± 12.2 years) underwent FET surgery. Underlying pathologies were thoracic aneurysm in 35 patients, acute aortic dissection in 25 patients and chronic dissection in 32 patients. Thirty patients underwent a simplified FET technique with deployment of the stent graft in arch zone 2 with an extra-anatomic bypass to the distal left subclavian artery using the third branch of the Thoraflex™ Hybrid Plexus prosthesis via a supraclavicular access during reperfusion. These patients were compared to 62 patients who received the conventional FET procedure, in which a distal anastomosis is performed in arch zone 3.RESULTS: Circulatory arrest (41.7 ± 10.5 vs 76.5 ± 33.0 min; P < 0.001) and antegrade cerebral perfusion times (60.9 ± 13.5 vs 92.1 ± 33.1 min; P < 0.001) were significantly reduced in zone 2 vs zone 3 patients, respectively. The 30-day mortality rate was 3.3% (n = 1) in zone 2 patients vs 17.7% (n = 11) in zone 3 patients (P = 0.75). Stent deployment in zone 2 was associated with significantly reduced rates of postoperative stroke [zone 2: n = 0 (0.0%); zone 3: n = 11 (17.7%), P = 0.046] and recurrent nerve palsy [zone 2: n = 1 (3.3%); zone 3: n = 14 (22.6%), P = 0.020).CONCLUSIONS: Simplifying the FET procedure leads to reduced circulatory arrest and cerebral perfusion times and improves early outcome.

U2 - 10.1093/ejcts/ezz082

DO - 10.1093/ejcts/ezz082

M3 - SCORING: Journal article

C2 - 30957865

VL - 56

SP - 738

EP - 745

JO - EUR J CARDIO-THORAC

JF - EUR J CARDIO-THORAC

SN - 1010-7940

IS - 4

ER -