Combined Surgical and Endovascular Repair of Complex Aortic Pathologies With a New Hybrid Prosthesis

Gorlitzer, Michael; Weiss, Gabriel; Thalmann, Markus; Mertikian, Gerard; Wislocki, Wojciech; Meinhart, Johann; Waldenberger, Ferdinand; Grabenwöger, Martin

doi:10.1016/j.athoracsur.2007.07.010

Cited by 48 publications

(32 citation statements)

References 20 publications

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“…Table 3 shows that, since the first surgical experience by Kato during the mid 1990s [4], different case series have been published, reporting good early and midterm results. Inhospital mortality seems to be improved in comparison to the conventional ET (6.4% vs 10.2%, respectively) [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. In a recent review published in 2008, FET has even been considered the standard treatment for extended aortic aneurysm as an alternative to conventional ET, as it allows for one-stage repair of combined aortic arch and proximal descending aortic aneurysm [60].…”

Section: Fet Techniquementioning

confidence: 95%

“…The proximal non-stented part is used to fix the prosthesis to the distal aortic arch and to allow for reconstruction of the arch itself. Different prostheses have been developed, both 'homemade' [4,[40][41][42][43][44][45][46][47][48][49][50] and commercially available, such as the ChavanHaverich (Curative Medical Devices GmbH, Dresden, Germany) [51] and the E-vita open (JOTEC GmbH, Hechingen, Germany) [52][53][54]. Stent grafts already commercially available for treating descending and abdominal aorta pathology, such as the GoreTAG (W.L.…”

Section: Fet Techniquementioning

confidence: 99%

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Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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The treatment of complex aortic pathology involving both the ascending and descending aortic segments at the same time represents a surgical challenge, with high postoperative morbidity and mortality rates reported. Over the past 27 years, different open surgical and endovascular techniques have been introduced and applied in various two-stage- or one-stage approaches to such cases. Thus, in 1983, Hans Borst significantly changed the traditional two-stage approach by introducing his elephant trunk technique. Leaving a segment of Dacron prosthesis reaching into the descending aorta during the first stage, the second-stage replacement of the residual dilated descending aorta was made far easier. The presence of interval mortality between the two stages, the unaffected need for two large operations to complete aortic repair, and the general failure of some patients to return for the second-stage repair set the scene for the development of one-stage procedures, both open surgical or hybrid surgical and endovascular, such as the frozen elephant trunk. However, the size of the operation, on the one hand, and the risk of spinal cord injury and need for surgical or endovascular completion during follow-up, on the other, have dampened enthusiasm. Recently, the introduction of supra-aortic debranching and endovascular aortic arch stent-graft repair has yet extended treatment to high-risk patients unsuitable to the more aggressive surgery, but mid- and long-term follow-up results are lacking. The lack of randomization and the presence of procedural and complication-related limitations for each technique do not allow for definitive conclusions about the ideal procedure to treat complex aortic pathology. However, the technical revolution experienced over the past 27 years, along with the improvement in perioperative management, has produced outstanding morbidity and mortality results even in this challenging patient population, but the decision regarding which pathology correlates with what operation remains highly debated and dependent also on regional competence.

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Section: Fet Techniquementioning

confidence: 95%

Section: Fet Techniquementioning

confidence: 99%

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…The E-vita Open, which is the only stent graft that is currently commercially marketed, has been reported to have a survival rate of 100% during the average follow-up period of 11 months, and no stent graft-related complications were observed in the reported studies. 6 In the present case, we used a newly developed stent graft, and observed an excellent patient response during the early postoperative period. However, a long-term follow-up is necessary, and we hope to experience more cases in order to obtain a better evaluation of the effectiveness and possible adverse effects of this device in the future.…”

Section: Discussionmentioning

confidence: 86%

“…[2][3][4] However, most grafts that are used for open stent implantation are currently self-produced stent grafts, and the E-vita Open (Jotec, Hechingen, Germany) is the only commercial graft that integrates a stent with a graft. 5,6 The experimental stent grafts (Ube CL-0201; Ube Medical, Tokyo, Japan) reported here are composed of a woven polyester graft and a nickel-titanium alloy stent, and have been used in clinical trials at four institutions in Japan (Osaka University, Hiroshima-City Asa General Hospital, Kishiwada Tokushukai Hospital, and Nihon University) beginning in 2008. We experienced a case in which a total arch replacement and an open stent implantation were performed using this new stent graft.…”

Section: Introductionmentioning

confidence: 99%

Total arch replacement and open stent graft implantation using a newly developed stent graft: Report of a case

et al. 2011

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We experienced a case in which a total arch replacement and an open stent implantation were performed for a distal aortic arch aneurysm using a newly developed stent graft (Ube CL-0201; Ube Medical, Tokyo, Japan). This novel stent graft is composed of a woven polyester graft and a nickel-titanium alloy stent, and has been under evaluation in clinical trials at four institutions in Japan, including our hospital, since 2008. The patient was weaned from the respirator on the day after surgery, and 9 months have passed since the surgery with no complications. A follow-up computed tomography scan showed that the stent part was sufficiently open, and no complications, such as an endoleak, have been observed.

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“…These findings underline the potential role of combined approaches such as the frozen elephant trunk procedure in order to treat the entire thoracic aortic disease to avoid late complications [13,14]. Ongoing evaluations of these approaches will confirm their broader use in the future or will put them into question [15,16].…”

Section: Commentmentioning

confidence: 91%

What makes the difference between the natural course of a remaining type B dissection after type A repair and a primary type B aortic dissection?

Czerny¹,

Roost-Krähenbühl²,

Sodeck³

et al. 2012

Thorac cardiovasc Surg

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OBJECTIVES: To analyse the outcome and need for intervention [surgery or thoracic endovascular aortic repair (TEVAR)] in patients after surgery for remaining type B dissection after type A repair and primary type B aortic dissection. METHODS:Within a 10-year period, 247 patients with remaining type B after type A, and 112 patients with primary type B aortic dissection were analysed. We assessed the clinical outcome as well as the need for intervention (surgery or TEVAR) within the aortic arch and the thoracoabdominal aorta as well as risk factors. RESULTS:The median follow-up was 23 months (interquartile range 5-52). There was a significant difference with regard to the status of the primary entry tear between patients after surgical repair of an acute type A aortic dissection and primary acute type B aortic dissection ( patent vs. non-patent entry 35 vs. 83%, P < 0.001). The overall need for any kind of intervention (surgery or TEVAR) was 19%. Multivariate Cox regression analysis revealed a patent primary entry tear in patients after surgery for acute type A aortic dissection as an independent predictor for intervention (surgery or TEVAR) during follow-up [odds ratio (OR) 6.4; confidence interval (CI) 1.39-29.81, P = 0.017]. Multivariate Cox regression analysis did not reveal a patent primary entry tear in patients after acute type B aortic dissection as an independent predictor for intervention (surgery or TEVAR) during follow-up (OR 0.67; CI 0.27-1.69, P = 0.671). Finally, the thrombosis status of the false lumen was not an independent predictor for intervention (surgery or TEVAR) either in patients after surgery for acute type A aortic dissection (OR 3.46; CI 0.79-15.16, P = 0.100) or in patients after acute type B aortic dissection (OR 0.77; CI 0.31-1.93, P = 0.580).CONCLUSIONS: A remaining type B dissection after type A repair and a primary type B aortic dissection represent two distinct pathophysiological entities with regard to late outcome. The need for any kind of intervention in the thoracoabdominal aorta is significantly higher in primary type B aortic dissections. A remaining patent primary entry tear independently predicts the need for intervention (surgery or TEVAR) in patients after surgery for acute type A aortic dissection and, thereby, remains the main target of initial therapy. The thrombosis status of the false lumen seems to be of secondary importance.

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Combined Surgical and Endovascular Repair of Complex Aortic Pathologies With a New Hybrid Prosthesis

Cited by 48 publications

References 20 publications

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Total arch replacement and open stent graft implantation using a newly developed stent graft: Report of a case

What makes the difference between the natural course of a remaining type B dissection after type A repair and a primary type B aortic dissection?

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