Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection

Abstract

OBJECTIVES We investigated the outcomes of a fenestrated frozen elephant trunk (FET) technique performed without reconstruction of one or more supra-aortic vessels for aortic repair in patients with acute type A aortic dissection. METHODS We investigated 22 patients who underwent the fenestrated FET technique for acute type A aortic dissection at our hospital between December 2017 and April 2020. The most common symptom was chest pain and/or back pain. Nine patients presented with malperfusion and 1 with cardiac arrest, preoperatively. A FET was deployed under hypothermic circulatory arrest and manually fenestrated under direct vision. Single fenestration was made in the FET in 15 patients, 2 fenestrations in 5 patients and a total fenestrated technique in 2 patients. Concomitant procedures were performed in 5 patients. RESULTS The cardiopulmonary bypass, aortic cross-clamp and hypothermic circulatory arrest times were 181 ± 49, 106 ± 43 and 37 ± 7 min, respectively. In-hospital mortality, stroke, or recurrent nerve injury did not occur in any patient. One patient developed paraparesis, which completely recovered at discharge. During the follow-up period (mean 18 ± 7 months), 1 patient died of heart failure. Fenestration site occlusion did not occur. Follow-up computed tomography (mean 12 ± 6 months postoperatively) revealed that the maximal aortic diameter remained unchanged at the levels of the distal end of the FET, the 10th thoracic vertebra and the coeliac artery; however, the aortic diameter was significantly reduced at the level of the pulmonary artery bifurcation. CONCLUSIONS The fenestrated FET technique is a simple, safe and effective procedure for selected patients with acute type A aortic dissection.

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).…”

Endovascular treatment after the fenestrated frozen elephant trunk technique

“… 2 However, complications include endoleaks from fenestration. 2 TAR using the FET technique for acute type‐A aortic dissection has favorable early and late postoperative outcomes. 4 , 5 Endovascular interventions after FET have often been reported.…”

“… 1 Recently, favorable surgical outcomes after fenestrated FET for acute type‐A aortic dissection have been reported. 2 However, reports describing the need for additional treatment after surgical treatment of acute aortic dissection with fenestrated FET are few. 2 We report the successful use of endovascular surgery to treat an endoleak following fenestrated FET for acute type‐A aortic dissection.…”

Effects of a frozen elephant trunk on postoperative renal dysfunction in acute type A aortic dissection extending into the renal artery

“…We selected an FET of optimal length to ensure that the distal end of the FET was placed in the straight segment of the descending aorta. Among 29 patients with the FET prosthesis, 21 patients underwent the fenestrated FET technique, which involves perfusion of one or more supra‐aortic vessels via fenestration in the FET 9–11 . The distal end of the transected aorta was reinforced with a felt strip, and a 4‐branched J graft (Japan Lifeline) was anastomosed using 4‐0 polypropylene running sutures.…”