Endovascular reintervention after frozen elephant trunk: where is the evidence?

Geragotellis, Alexander; Surkhi, Abedalaziz O.; JUBOURI, Matti; ALSMADI, Ayah S.; EL-DAYEH, Yazan; KAYALI, Fatima; MOHAMMED, Idhrees; BASHIR, Mohamad

doi:10.23736/s0021-9509.22.12393-1

Cited by 11 publications

(17 citation statements)

References 48 publications

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“…Here, 14.5% of patients in the Thoraflex Hybrid developed dSINE post-FET relative to 18.2% with E-Vita Open (P = 0.19). The Frozenix HP, however, was found to be associated with the highest incidence of dSINE whilst, on the other hand, no dSINE data was identified for Cronus due to its geographical confinement leading to paucity of data [9,81]. Lastly, Thoraflex Hybrid unique circular design and special material have been shown to actually reduce the stress on the aortic wall, contributing to the excellent dSINE results seen across the literature as well as in our study [9,10,82].…”

Section: Discussionmentioning

confidence: 56%

“…Importantly, untreated endoleak negatively influences the aortic remodeling process by contributing to constant AL expansion. Therefore, the FET stent-graft size and length must be selected carefully after accurate measurement [9,10,46,81]. Kandola et al [46] noted that 77% of patients with endoleak or sac expansion had < 10% of distal stent oversizing whilst the remaining 23% had less than 30 mm distal seal in the healthy portion of the aorta despite adequate oversizing.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, FET graft size and length has been strongly linked to these outcomes. This topic has been discussed in detail by Jubouri et al [9] and Kayali et al [81]. Research evidence has demonstrated that severe graft oversizing increases the likelihood of dSINE occurring which, in turn, negatively affects aortic remodeling, while at the same time independently causing negative remodeling [9,10,59] .…”

Section: Discussionmentioning

confidence: 99%

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

Jubouri

Nakhaei

Bashir

et al. 2022

Preprint

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Background: The introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortovascular surgery. However, although FET yields excellent results, the risk of certain complications requiring secondary intervention remains present, negating its one-step hybrid advantage over conventional techniques. This systematic review and meta-analysis sought to evaluate controversies regarding the incidence of FET-related complications, with a focus on aortic remodeling, distal stent-graft induced new entry (dSINE) and endoleak, in patients with type A aortic dissection (TAAD) and/or thoracic aortic aneurysm. Materials and methods: A comprehensive literature search was conducted using multiple electronic databases including EMBASE, Scopus, and PubMed/MEDLINE to identify evidence on TAR with FET in patients with TAAD and/or aneurysm. Studies published up until January 2022 were included, and after applying exclusion criteria, a total of 43 studies were extracted. Results: A total of 5068 patients who underwent FET procedure were included. The pooled estimates of dSINE and endoleak were 2% (95% CI 0.01-0.06, I = 78%) and 3% (95% CI 0.01-0.11, I = 89%), respectively. The pooled rate of secondary thoracic endovascular aortic repair (TEVAR) post-FET was 7% (95% CI 0.05-0.12, I = 89%) whilst the pooled rate of false lumen thrombosis at the level of stent-graft was 91% (95% CI 0.75-0.97, I = 92%). After subgroup analysis, heterogeneity for dSINE and endoleak resolved among European patients, where Thoraflex Hybrid and E-Vita stent-grafts were used (both I = 0%). In addition, heterogeneity for secondary TEVAR after FET resolved among Asians receiving Cronus (I = 15.1%) and Frozenix stent grafts (I = 1%). Conclusion: Our results showed that the FET procedure in patients with TAAD and/or aneurysm is associated with excellent results, with a particularly low incidence of dSINE and endoleak as well as highly favorable aortic remodeling. However the type of stent-graft and the study location were sources of heterogeneity, emphasizing the need for multicenter studies directly comparing FET grafts. Finally, Thoraflex Hybrid can be considered the primary FET device choice due to its superior results.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Jubouri

Nakhaei

Bashir

et al. 2022

Preprint

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“…Additionally, freedom from adverse events at 84 months was 95% [10]. Lastly, a recent review by Geragotellis et al [11] showcased the favourable reintervention rates associated with TAR using FET.…”

Section: Coi and Funding: Nonementioning

confidence: 97%

Total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Aggressive versus conservative

Jubouri

Ansari

Zaqout

et al. 2022

Preprint

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Background: Acute type A aortic dissection (ATAAD) is a life-threatening medical condition requiring urgent surgical attention. It is estimated that 50% of ATAAD die within 24 hours of onset, with the mortality rate is increasing by 1-2% every additional hour without prompt intervention. A variety of ATAAD surgical repair techniques exist which has sparked controversy within the literature, with the main two strategies being proximal aortic replacement (PAR) and total arch replacement (TAR). Nevertheless, the question of which of these two strategies if the more optimal is still debatable. Aims: This commentary aims to discuss the recent study by Sa and colleagues which presents a pooled analysis of Kaplan-Meier-derived individual patient data from studies with follow-up comparing aggressive (TAR) and conservative (PAR) approaches to manage ATAAD patients. Methods: A comprehensive literature search was performed using multiple electronic databases including PubMed, Ovid, Google Scholar, EMBASE and Scopus in order to collate the relevant research evidence. Results: The more aggressive TAR approach for treating ATAAD seems to yield more favourable results including more optimal long-term survival as well as a lower need for reoperation. The frozen elephant trunk (FET) technique can be considered the mainstay TAR technique. Conclusion: It is valid to conclude that TAR with FET is the superior strategy for managing ATAAD patients.

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“…These include potential adverse aortic remodeling, distal stent‐graft induced new entry (DSINE) and endoleak which requires secondary intervention 2,3 . Endoleak is defined across the literature as an unsatisfactory seal located at the site of the stent‐graft anastomosis at either its proximal or distal end, typically requiring secondary intervention 4 . DSINE can be defined as a new tear occurring as a result of the stent graft itself and is caused exclusive of iatrogenic injury or natural disease progression 5 .…”

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confidence: 99%

Adverse complications of frozen elephant trunk, do we have enough quality data?

Howard

Al-Tawil

Geragotellis

et al. 2022

Journal of Cardiac Surgery

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Background: Frozen elephant trunk has in recent times become a mainstay for total arch replacement in aortovascular surgery and is indicated to treat a spectrum of complex aortic pathologies. However, despite associated excellent postoperative results it is incredibly important to recognize potential adverse complications such as negative aortic remodeling, endoleak, and distal stent-graft induced new entry so that outcomes can be further improved.Aim of the study: Below we provide commentary on a recent article in the Journal of Cardiac Surgery discussing the topic.Conclusions: Despite the fascinating outcomes of this systematic review and metaanalysis the heterogeneity of the literature regarding these adverse outcomes remains an issue which can only be solved with large multicenter trials directly comparing graft types as well as indications for surgery.aortic remodeling, DSINE, endoleak, frozen elephant trunk Frozen elephant trunk (FET) as a technique for the treatment of patients with complex pathologies of the aortic arch has emerged in recent times as a leading method for total arch replacement. 1 FET is recognized in the literature for generally providing superior intra and postoperative outcomes however the technique is not without complications. These include potential adverse aortic remodeling, distal stent-graft induced new entry (DSINE) and endoleak which

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Endovascular reintervention after frozen elephant trunk: where is the evidence?

Cited by 11 publications

References 48 publications

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

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

Total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Aggressive versus conservative

Adverse complications of frozen elephant trunk, do we have enough quality data?

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