Frozen elephant trunk with modified en bloc arch reconstruction and left subclavian transposition for chronic type A dissection

Zhong, Yongliang; Qi, Rui-Dong; Ma, Wei-Guo; Ge, Yipeng; Qiao, Zhiyu; Li, Cheng-Nan; Zhu, Jun; Sun, Lu

doi:10.21037/jtd.2018.08.140

Cited by 15 publications

(10 citation statements)

References 30 publications

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“…Our surgical technique of TAR and FET (the Sun operation) has been described in detail previously (7,8,(16)(17)(18). We routinely use unilateral selective antegrade cerebral perfusion through right axillary cannulation and moderate hypothermic circulatory arrest at 20-25 ℃.…”

Section: Surgical Indications and Techniquesmentioning

confidence: 99%

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Is the frozen elephant trunk technique justified for chronic type A aortic dissection in Marfan syndrome?

Chen¹,

Ma²,

Lǐ³

et al. 2020

Ann Cardiothorac Surg

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Background: Chronic type A aortic dissection (cTAAD) in Marfan syndrome (MFS) is rare. Surgical experience is limited and the role of frozen elephant trunk (FET) technique remains undefined. We seek to evaluate the safety and efficacy of the total arch replacement (TAR) and FET technique for cTAAD in MFS. Methods:The clinical data of sixty-eight patients with MFS undergoing FET and TAR for cTAAD were analyzed.Results: Mean age was 35.8±9.7 years and thirty-nine were male (57.4%). Operative mortality was 10.3% (7/68). Stroke occurred in one (1.5%), re-exploration for bleeding in five (7.3%), low cardiac output in four (5.9%), and acute renal failure in two (2.9%). Follow-up was complete in 100% (61/61) at mean 7.3±4.0 years. The false lumen was obliterated in 73.5% across FET and 50.0% in unstented descending aorta (DAo).Distal dilation occurred in twenty patients, six of whom underwent thoracoabdominal aortic replacement, one abdominal aortic replacement and one thoracic endovascular aortic repair (TEVAR). Late death occurred in five. At ten years, 59.8% were free from distal aortic dilation, and the incidences were 23.2% for death, 14.4% for distal reoperation, and 62.4% for reoperation-free survival. Predictors for operative mortality were extra-anatomic bypass [odds ratio (OR), 229.592; P=0.036], preoperative maximal size (DMax) of aortic sinuses (mm) (OR, 1.134; P=0.032) and cardiopulmonary bypass (CPB) time (minute) (OR, 1.061; P=0.041). Risk factors for aortic dilatation included patent false lumen at diaphragmatic hiatus [hazard ratio (HR), 5.374; P=0.008], preoperative DMax (mm) of proximal DAo (HR, 1.068; P=0.001) and renal arteries (HR, 1.102; P=0.005) which also predicted distal reoperation (HR, 1.149; P=0.001). The time from onset to operation (day) (HR, 1.002; P=0.004) and CPB time (minute) (HR, 1.032; P=0.036) predicted late death.Conclusions: This study shows that the TAR and FET technique is a safe and durable approach to cTAAD in patients with MFS. The operation should be performed as early as possible to optimize clinical outcomes.

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Section: Surgical Indications and Techniquesmentioning

confidence: 99%

“…In selected patients, the arch branches were reconstructed using a modified en bloc technique (17,18). Near-infrared spectroscopy, bispectral index, and cerebrospinal fluid drainage are used in high-risk patients.…”

Section: Surgical Indications and Techniquesmentioning

confidence: 99%

Is the frozen elephant trunk technique justified for chronic type A aortic dissection in Marfan syndrome?

Chen¹,

Ma²,

Lǐ³

et al. 2020

Ann Cardiothorac Surg

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“…A four-branched graft was used in TAR combined with stented elephant trunk (SET) implantation under the condition of HCA and SCP. The en bloc technique was described by Zhong et al ( 15 ). The anterior wall of the aortic arch was incised longitudinally up to the origin of the left common carotid artery (LCCA); no dissection of the arch vessels was confirmed intraoperatively.…”

Section: Methodsmentioning

confidence: 99%

Surgical treatment strategies for patients with type A aortic dissection involving arch anomalies

Zhu

Tong

Zhuang

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThe aim of the study was to investigate surgical modalities and outcomes in patients with type A aortic dissection involving arch anomalies.MethodPatients with type A aortic dissection who underwent surgical treatment at our center between January 2017 and 31 December 2020 were selected for this retrospective analysis. Data including computed tomography (CT), surgical records, and cardiopulmonary bypass records were analyzed. Perioperatively survived patients were followed up, and long-term mortality and aortic re-interventions were recorded.ResultA total of 81 patients with arch anomalies were included, 35 with “bovine” anomalies, 23 with an aberrant right subclavian artery, 22 with an isolated left vertebral artery, and one with a right-sided arch + aberrant left subclavian artery. The strategies of arch management and cannulation differed according to the anatomic variation of the aortic arch. In total, seven patients (9%) died after surgery. Patients with “bovine” anomalies had a higher perioperative mortality rate (14%) and incidence of neurological complications (16%). Overall, four patients died during the follow-up period, with a 6-year survival rate of 94.6% (70/74). A total of four patients underwent aortic re-intervention during the follow-up period; before the re-intervention, three received the en bloc technique (13.6% 3/22) and one received hybrid therapy (11.1% 1/9).ConclusionWith complete preservation and reconstruction of the supra-arch vessels, patients with type A aortic dissection combining arch anomalies can achieve a favorable perioperative prognostic outcome. Patients who received the en bloc technique are more likely to require aortic re-intervention than patients who underwent total arch replacement with a four-branched graft vessel. Cannulation strategies should be tailored according to the variation of anatomy, but routine cannulation with the right axillary artery can still be performed in most patients with arch anomalies, even for patients with an aberrant right subclavian artery.

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“…Island technique arch reconstruction was performed when there was no involvement of the brachiocephalic trunk and the left common carotid artery. Detailed procedures were described previously ( 14 , 15 ).…”

Section: Methodsmentioning

confidence: 99%

Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique

Luo

Zhong

et al. 2021

Front. Cardiovasc. Med.

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Background: This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection.Methods: From February 2009 to December 2019, 79 patients diagnosed with chronic type B or non-A non-B aortic dissection who underwent the FET procedure were included in the present study. We analyzed operation mortality and early and long-term outcomes, including complications, survival and interventions.Results: The operation mortality rate was 5.1% (4/79). Spinal cord injury occurred in 3.8% (3/79), stroke in 2.5% (2/79), and acute renal failure in 5.1% (4/79). The median follow-up time was 53 months. The overall survival rates were 96.2, 92.3, 88.0, 79.8, and 76.2% at 1/2, 1, 3, 5 and 7 years, respectively. Moreover, 79.3% of patients did not require distal aortic reintervention at 7 years. The overall survival in the subacute group was superior to that in the chronic group (P = 0.047).Conclusion: The FET technique is a safe and feasible approach for treating chronic type B and non-A non-B aortic dissection in patients who have contraindications for primary endovascular aortic repair. The technique combines the advantages of both open surgical repair and endovascular intervention, providing comparable early and long-term follow-up outcomes and freedom from reintervention.

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Frozen elephant trunk with modified en bloc arch reconstruction and left subclavian transposition for chronic type A dissection

Cited by 15 publications

References 30 publications

Is the frozen elephant trunk technique justified for chronic type A aortic dissection in Marfan syndrome?

Is the frozen elephant trunk technique justified for chronic type A aortic dissection in Marfan syndrome?

Surgical treatment strategies for patients with type A aortic dissection involving arch anomalies

Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique

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