Frozen elephant trunk with straight vascular prosthesis: single-center experience with a review of current trends

Jakob, Heinz; Moughal, Saad; Bashir, Mohamad

doi:10.23736/s0021-9509.20.11401-0

Cited by 12 publications

(25 citation statements)

References 32 publications

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“…With increasing in popularity, over 30,000 hybrid prostheses have been implanted across the globe 1 . The understanding of aortic pathology and the pathophysiological mechanisms coupled with the advancements in the techniques and technology has produced excellent long term results of survival probability of 5 years for acute Type A aortic dissection, chronic aortic dissection and thoracic aortic aneurysm at 91%, 98%, and 92%, respectively 2 …”

Section: Introductionmentioning

confidence: 99%

From E‐VITA open plus to E‐VITA NEO and E‐NOVIA

Jakob

Idhrees²,

Bashir

2020

J Card Surg

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The first clinical implantation of the “Essen I prosthesis” took place in 2005, which was then followed by E‐Vita open plus. With further advancements E‐Vita Neo and E‐Novia was introduced. These devices enable the surgeons to perform frozen elephant trunk in zone 0/1 which eventually reduce the incidence of paraplegia, recurrent laryngeal nerve palsy and proximalization of supraaortic arch vessels. E‐vita open plus and successors alleviate frozen elephant trunk operations rendering more stable results in promoting positive remodelling of the distal aorta.

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Section: Introductionmentioning

confidence: 99%

From E‐VITA open plus to E‐VITA NEO and E‐NOVIA

Jakob

Idhrees²,

Bashir

2020

J Card Surg

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“…2 Since then, as a new trend of thoracic aortic surgery emerged with commercially available devices from Europe and China, the FET procedure frequently has been applied to open arch repairs for aortic dissection (AD) and aneurysms. [3][4][5][6][7][8][9][10][11][12][13] The current application of FET is for 1-stage exclusion of an arch aneurysm or for dilatation of the true lumen and early closure of the false one (aortic remodeling) with inside reinforcement of the dissecting aortic stump in AD. On the other hand, in Japan, Kato and colleagues 14 initiated a new graft-implanting method, known as the "open stent graft," similar to the FET procedure in the mid-1990s.…”

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confidence: 99%

“…On the other hand, in Europe and China, the new trend toward FET was developed with recent advances in endografting repairs. [3][4][5][6][7][8][9][10][11][12][13] Many articles on TARFET have been published with the development of factory-made devices. Worldwide discussions on FET have been focused on the following issues: how to use TARFET, which aortic pathologies fit, and whether the procedure is useful or harmful.…”

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confidence: 99%

“…Furthermore, it was superior to those of the other series. [3][4][5][6][7][8][9][10][11][12][13] In a position paper by the EACTS Vascular Domain, the aggregated morbidity and mortality rates were described as in-hospital mortality in 1.8% to 17.2%, stroke in 2.5% to 20%, and SCI in 0% to 21%. 9 Another meta-analysis reported in-hospital mortality in 8.8% (0%-40.9%), stroke in 7.6% (0%-24%), and paraplegia in 4.7% (0%-21.6%).…”

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confidence: 99%

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Comparative study of Japanese frozen elephant trunk device for open aortic arch repairs

Ogino

Okita

Uchida

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Objective: We performed a multicenter prospective comparative study to determine the impact of a Japanese frozen elephant trunk device on total arch replacement compared with conventional repair without it.Methods: Between 2016 and 2019, a total of 684 patients (frozen elephant trunk procedure; n ¼ 369; conventional repair, n ¼ 315) from 41 institutions were enrolled. The 2 procedures were selected according to each center's strategy.Results: The frozen elephant trunk procedure was applied more for aortic dissection, whereas the conventional repairs were predominantly performed for aneurysms. In the former, only hypothermic circulatory arrest time was reduced among the intraoperative parameters. Although there were no differences in the 30-day and in-hospital mortality rates (0.8% and 1.6%, respectively, for the frozen elephant trunk procedure vs 0.3% and 0.6%, respectively, for conventional repair), the neurologic complication rates were significantly higher in stroke (5.7% vs 2.2%; P ¼ .022) and paraplegia (1.6% vs 0%; P ¼ .023). In the propensity score matching analyses using 11 variables, statistical significance disappeared in the differences for mortality and neurologic morbidity (stroke and paraplegia/paraparesis) rates of 194 patients of each group, although they were still higher for the frozen elephant trunk procedure. Conclusions:The early outcomes of total arch replacement with the frozen elephant trunk procedure were acceptable despite its higher prevalence of emergency or redo surgery, which was comparable to that of the conventional repair. This procedure had higher rates of spinal cord injury than the conventional repair, which is a disadvantage of this approach.

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“…The overall results depends on several other factors which includes (i) Lower body protection during circulatory arrest: Adequate cooling of the patient and maintain a short circulatory arrest period. If need intermittent perfusion of lower body with a Foley's catheter (ii) Continuous perfusion of left subclavian artery: Continuous perfusion through the left subclavian artery would encourage collateral circulation to the spinal cord during the circulatory arrest period (7,8) (iii) Minimal Handling of the atherosclerotic plaques on the aorta (iv) Through deairing of the descending thoracic aorta, prior to restarting lower body circulation.…”

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confidence: 99%