Early and mid-term results of frozen elephant trunk procedure for acute type A aortic dissection

Ateş, Mustafa; Ak, Adnan; Arslan, Özgür; Çekmeceli̇oğlu, Davut; Tas, Serpil; Dönmez, Arzu Antal; Şişmanoğlu, Mesut; Tunçer, Mehmet Altuğ

doi:10.5606/tgkdc.dergisi.2019.16879

Cited by 15 publications

(13 citation statements)

References 23 publications

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“…In agreement with our study, a work done in Turkey by Akbulut et al reported that 93.9% and 54.4% of patients had thrombosed false aortic lumen at pulmonary and diaphragmatic levels, respectively, after one month of frozen elephant trunk implantation [ 9 ]. Kuroda et al reported a significant shrinkage of the false aortic lumen in the frozen elephant trunk segment, but did not find significant change in the false lumen in descending aorta, diaphragmatic hiatus and renal artery segments as the false lumen remained stable [ 10 ] Ouzounian et al reported a significant reduction in the diameter of the false aortic lumen following frozen elephant trunk surgery up to one-year follow-up of patients [ 11 ].…”

Section: Discussionsupporting

confidence: 93%

Aortic remodelling and false lumen changes after the frozen elephant trunk technique using the thoraflex hybrid stented graft for aortic dissection

et al. 2021

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Background Despite the marked improvement in the aortic dissection repair techniques, residual dissected aorta with a patent false lumen remains an issue. So, the aim of our study is to observe the effect of inserting the Thoraflex Hybrid Graft on the aortic diameters in patients with type A aortic dissection involving the arch and descending aorta. Patients with type I aortic dissection who had aortic dissection repair using the Thoraflex Hybrid Graft in University Hospitals Birmingham were studied. Radiological assessment with computed tomography of the aorta was done at the level of the diaphragm to measure the true lumen, false lumen and total aortic diameters. Significance of change of diameters at early post-operative as compared to the pre-operative period was analysed. Results Eight cases were done in the acute setting, while 14 cases were done in the chronic setting. The ratio of true lumen to the total aortic diameter has significantly increased in the follow-up period as compared to the pre-operative period (P = 0.031). Whereas false lumen to total aortic diameter ratio has significantly decreased (P = 0.024). Subgroup analysis revealed that these changes were not significantly altered by whether the dissection was acute or chronic. Conclusions The Thoraflex Hybrid Graft will induce positive aortic remodelling with expansion of true lumen and will diminish the false lumen. But we could not find a significant difference between acute or chronic cases due to small sample size.

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Section: Discussionsupporting

confidence: 93%

Aortic remodelling and false lumen changes after the frozen elephant trunk technique using the thoraflex hybrid stented graft for aortic dissection

et al. 2021

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“…After reviewing shreds of evidence, a total of 35 studies including 3211 patients were entered into the quantitative analysis (Figure 1). 11–44 The median size of reviewed reports was 72 patients (interquartile range 38 – 122). The majority of studies were performed in Chinese institutions, 19 studies including 2026 patients.…”

Section: Resultsmentioning

confidence: 99%

Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis

Mousavizadeh

Daliri

Aljadayel

et al. 2021

Journal of Cardiac Surgery

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Background The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta‐analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post‐operative neurologic outcomes. Methods A standard Preferred Reporting Items for Systematic Reviews and Meta‐Analyses search was conducted for all observational studies of patients diagnosed with ATAAD undergoing total arch replacement with FET reporting in‐hospital mortality, bleeding, and neurological outcomes. A random‐effect meta‐analysis was performed using STATA software (StataCorp, TX, USA). Results Thirty‐five studies were eligible for the present meta‐analysis, including 3211 patients with ATAAD who underwent total arch replacement with FET. The pooled estimate for in‐hospital mortality, postoperative stroke, and spinal cord injury were 7% (95% CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3% (95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta‐regression revealed that with increasing the duration of hypothermic circulatory arrest time, the effect sizes for postoperative stroke and SCI enhances. Conclusions It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.

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“…Of 64 studies reporting outcomes of patients included in this report 13–76 . The proportions of studies from Asia, Europe, and North America were 54.7%, 31.3%, and 10.9%, respectively.…”

Section: Methodsmentioning

confidence: 99%

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

et al. 2021

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Background and Aim of the Study The frozen elephant trunk (FET) procedure became a popular entity for utilization in aortic arch aneurysm disease. However, its proper mortality and morbidities as well as the predictors of outcomes are poorly identified. This systematic review and meta‐analysis explore FET outcomes and its predictors with a focus on zone aortic proximalization. Methods We searched PubMed/MEDLINE, EMBASE, and Scopus databases from their beginning to June 2020 to find studies reporting the outcomes of the FET procedure for the total arch replacement (TAR). Results A total of 64 studies including 7967 patients were evaluated. The pooled estimates of cerebrovascular accidents, paraplegia, renal failure, and in‐hospital mortality were 7.104 (95% confidence interval [CI], 5.691–8.661; I2 = 78.53%), 3.465 (95% CI, 2.852–4.136; I2 = 15.96), 14.969 (95% CI, 11.361–18.977; I2 = 91.26%), and 8.933 (95% CI, 7.128–10.919; I2 = 78.51%), respectively. Stratification by the geographical locations and by the aortic pathologies led to lower heterogeneity, but not for renal failure. The distal anastomosis in Zone 2 was associated with a lower rate of renal failure compared with Zone 3 (odds ratio, 0.54; 95% CI, 0.36–0.81; p = .003; I2 = 0%). Conclusions The FET procedure for TAR can be performed with acceptable mortality and morbidities among patients with complex aortic pathologies. Moreover, the distal anastomosis in Zone 2 was associated with lower renal failure compared to Zone 3.

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Early and mid-term results of frozen elephant trunk procedure for acute type A aortic dissection

Cited by 15 publications

References 23 publications

Aortic remodelling and false lumen changes after the frozen elephant trunk technique using the thoraflex hybrid stented graft for aortic dissection

Aortic remodelling and false lumen changes after the frozen elephant trunk technique using the thoraflex hybrid stented graft for aortic dissection

Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

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