A new dissection-specific hybrid stent graft for patients with DeBakey type I aortic dissection

Abstract

OBJECTIVES We present our first experience of using a new dissection-specific hybrid stent graft (SG) (the ‘Soft Elephant Trunk’) in the frozen elephant trunk technique, in patients with non-acute DeBakey type I aortic dissection. METHODS Between September 2016 and February 2021, patients with non-acute DeBakey type I aortic dissection underwent the frozen elephant trunk procedure at our centre using 3 SG types: group Z used stiff, distal Z-shaped nitinol SGs (E-Vita, Medtronic); group R used a stiff, ring-shaped nitinol SG (Thoraflex); and group S used a soft, distal dissection-specific SG. Predictors of distal SG-induced new entry were analysed. End points were hospital- and midterm-follow-up results. RESULTS The study comprised 109 patients with 46 (42.2%), 22 (20.2%) and 41 (37.6%) patients in groups Z, R and S, respectively. No significant differences were found in early outcomes. Freedom from distal SG-induced new entry was comparable in groups Z, R and S (68.9% vs 92.9% vs 100%, log-rank = 0.14). There was no significant difference in follow-up between the groups. Four-year survival rates were 80.44%, 71.59% and 95.06% in groups Z, R and S, respectively. On multivariable analysis, the presence of connective tissue disorders [hazard ratio (HR) = 5.62, P = 0.11] and SG diameter (HR = 1.37, P = 0.034) were strong predictors of distal SG-induced new entry. CONCLUSIONS Dissection-specific hybrid SG with a soft distal end is effective in patients with non-acute DeBakey type I aortic dissection. Compared to non-soft distal SGs, this can reduce the incidence of distal complications. Long-term outcomes are necessary to determine the potential advantages and disadvantages of the new prosthesis.

Aortic remodeling, distal stent‐graft induced new entry and endoleak following frozen elephant trunk: A systematic review and meta‐analysis

“…A total of 79,931 records were collected via online database review, out of which 7345 studies were eligible for abstract screening. After applying the exclusion criteria, 109 records were adopted for full‐text screening, and eventually, reported data of 43 studies including 5068 patients who underwent TAR with FET were reviewed 4,15–56 (Figure 1).…”

Thoracoscopic Clipping of Intercostal Artery for Treatment of Type II Endoleak Following Frozen Elephant Trunk Procedure: Case Report

“…In November 2020, we performed thoracic aorta repair with the FET technique using dissection-specific hybrid stent graft "Soft Elephant Trunk" 26 mm (MedInzh, Penza, Russia) on a 36-year-old patient with a history of Crawford extent I thoracoabdominal aneurysm and chronic type B 1,10 aortic dissection. 5 The maximum diameter of the descending thoracic aorta (DTA) was 44 mm (Fig. 1), with partial false lumen thrombosis at the level of stent graft (Th9) and an additional 3.7 mm fenestration at the diaphragm level (Fig.…”

What Is the Long-Term Clinical Efficacy of the Thoraflex™ Hybrid Prosthesis for Aortic Arch Repair?

“…In contrast, Thoraflex Hybrid TM was associated with an early mortality rate of 6% at one Hannover centre. Notably, Song et al reported 0 in-hospital mortalities in 16 patients treated with Cronus TM for ATAAD in Xiamen, China, between February 2018 and August 2019; while Charchyan et al more recently reported that though the difference in mortality rates between Thoraflex Hybrid TM and E-Vita TM for non-acute DeBakey type I aortic dissection were insignificant, Thoraflex Hybrid TM was associated with improved morbidity rates and freedom from dSINE (17,18).…”