Impact of the Frozen Elephant Trunk Technique on Total Aortic Arch Replacement

Hirano, Kōji; Tokui, Toshiya; Nakamura, Bun; Inoue, Ryosai; Inagaki, Masumi; Hirano, Reina; Chino, Shuji; Maze, Yasumi; Kato, Noriyuki; Takao, Motoshi

doi:10.1016/j.avsg.2019.10.075

Cited by 17 publications

(18 citation statements)

References 20 publications

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“…Terumo Aortic's Thoraflex TM Hybrid is an excellent FET device with very favorable survival outcomes that are to some extent superior to those offered by other commercially available devices. The incidence of dSINE with Thoraflex Hybrid TM can be considered the lowest within the aortic arch prostheses market as demonstrated above (9,20,24,25,(31)(32)(33)(34)(35)(36)(37).…”

Section: Distal Stent Induced New Entrymentioning

confidence: 96%

“…For example, the incidence of dSINE reported in the studies identified ranged from 0 to 14.5% with Thoraflex Hybrid TM , 1-18.2% with E-Vita, and 0-27.3% with Frozenix TM . The size and length of device used are interconnected with the incidence of dSINE (9,20,24,25,(31)(32)(33)(34)(35)(36)(37). A summary of all the dSINE findings to-be discussed in this section can be found in Table 5.…”

Section: Distal Stent Induced New Entrymentioning

confidence: 99%

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Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Jubouri

Kayali

Saha

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortivascular surgery by allowing hybrid repair of complex aortic pathologies in a single step through combining an open surgical approach with an endovascular one. FET has been associated with favorable aortic remodeling, however, its is also associated with development of distal stent graft induced new entry (dSINE) tears postoperatively. The rate of aortic remodeling and the incidence of dSINE have been linked together, in addition, there seems to be a relationship between these two variables and FET insetion length as well as graft size.AimsThe scope of this review is to highlight the rate of aortic remodeling as well the incidence of dSINE associated with different FET devices available commercially. This review also aimed to investigate the relationship between aortic remodeling, dSINE, FET insertion length and FET graft size.MethodsWe conducted a comprehensive literature search using multiple electronic databases including PubMed, Ovid, Scopus and Embase in order to collate all research evidence on the above mentioned variables.ResultsThoraflex™ Hybrid Plexus seems to yield optimum aortic remodeling by promoting maximum false thrombosis as well true lumen expansion. Thoraflex Hybrid™ is also associated with the lowest incidence of dSINE post-FET relative to the other FET devices on the market. Aortic remodeling and dSINE do influence each other and are both linked with FET graft length and size.ConclusionThe FET technique for TAR shows excellent aortic remodeling but is associated with a considerable risk of dSINE development. However, Thoraflex™ Hybrid has demonstrated itself to be the superior FET device on the aortic arch prostheses market. Since aortic remodeling, dSINE, FET insertion length and stent graft size are all interconnect, the choice of FET device length and size must be made with great care for optimum results.

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Section: Distal Stent Induced New Entrymentioning

confidence: 96%

Section: Distal Stent Induced New Entrymentioning

confidence: 99%

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Jubouri

Kayali

Saha

et al. 2022

Front. Cardiovasc. Med.

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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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“…If the primary entry was located beyond the left subclavian artery or greater curvature of the aorta, total arch replacement (TAR) was principally performed. In patients undergoing TAR, all distal anastomosis was performed using a conventional elephant trunk (ET) or frozen elephant trunk (FET) [11] depending on the age and patient situation.…”

Section: Operative Techniquesmentioning

confidence: 99%

Clinical Outcomes of Limited-repair Strategy and Conservative Approach for the Elderly With Acute Type A Aortic Dissection

Maze

Tokui

Murakami

et al. 2021

Preprint

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BackgroundThere is controversy regarding surgical indication and surgical procedure of acute type A aortic dissection for the elderly. We examined surgical outcomes for the elderly.MethodsFrom January 2012 to December 2019, 174 patients underwent surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the elderly group (≧80 years old) and the non-elderly group (≦79 years old). Additionally, we compared the surgical treatment group with the conservative treatment group.ResultsThe primary entry was found in the ascending aorta in 51.6% of the elderly group and in 32.8% of the non-elderly group (p= 0.049). In the elderly group, ascending or hemiarch replacement was performed in all cases, while in the non-elderly group, ascending or hemiarch replacement was performed in 57.3% (p<0.001). The hospital mortality was similar in both groups. The 5-year survival rate was 48.4±10.3% in the elderly group and 86.7±2.9% in the non-elderly group (p<0.001). The rates of freedom from aortic event at 5 years was 86.9±8.7% in the elderly group and 86.5±3.9% in the non-elderly group (p=0.771). The 5-year survival rate of conservative treatment group was 19.2±8.0% in the elderly. There was no significant difference from the surgical treatment group (p=0.103).ConclusionsThe surgical approach may not always be the reasonable treatment of choice for the elderly because the significant survival merit was not achieved compared with the conservative approach.

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Impact of the Frozen Elephant Trunk Technique on Total Aortic Arch Replacement

Cited by 17 publications

References 20 publications

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

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

Clinical Outcomes of Limited-repair Strategy and Conservative Approach for the Elderly With Acute Type A Aortic Dissection

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