Is the frozen elephant trunk frozen?

Bartolomeo, Roberto Di; Murana, Giacomo; L, Di Marco; Alfonsi, Jacopo; Gliozzi, Gregorio; Amodio, Ciro; Leone, Alessandro; Pacini, Davide

doi:10.1007/s11748-018-0911-4

Cited by 22 publications

(14 citation statements)

References 28 publications

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“…Based on our data for stents made from a tubular blank, we consider the height of the cell and the method of nitinol thermal shape setting to be factors of the major significance. Thus, in SH1 and SH2, elements with S CS 0.25 mm 2 and a height of 15 mm were used; those were much softer than SH3 and SH4 with cells 12.5 mm high and S CS 0.20 mm 2 . Although for wire stents, this relationship may be somewhat different, but it can be modified by varying the height and S CS of the structure cells.…”

Section: Discussionmentioning

confidence: 99%

“…The technique uses conventional crimped synthetic prostheses that are usually sutured to a stent-graft at the manufacturing stage ( Figure 1 ). This approach simplifies and speeds up the operation, and also standardizes its technical aspects [ 2 ]. Hybrid prostheses can have additional branches in the area of the crimped prosthesis, for example, brachiocephalic and perfusion branches.…”

Section: Introductionmentioning

confidence: 99%

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Ab ovo: Factors Affecting the Radial Stiffness of Thoracic Aorta Stent-Grafts

Zhuravleva¹,

Timchenko²,

Vladimirov³

et al. 2021

Sovrem Tehnol Med

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The aim of the investigation was to study the factors influencing the radial stiffness of the thoracic aorta stent-grafts with the stent elements made of nitinol tubes by laser cutting and thermal shape setting. Materials and Methods. The work used stent elements made by different technologies by two different manufacturers from a nitinol tube with a wall thickness of 0.5 mm (E1) and 0.4 mm (E2), with a final diameter of 20 mm. Height of cells E1-15 mm, E2-12.5 mm. The stents were manually attached to a tubular woven non-crimped base (PTGO Sever, Russia) with a 6/0 suture, resulting in either single or continuous stitches. In the RLU124 radial force tester (Blockwise Engineering LLC, USA), each of the four stent-grafts, as well as their individual stent elements, were compressed by 10 mm from the initial diameter. The dependence of the radial forces on deformation under loading and unloading was graphically presented. The temperature and enthalpy of phase transitions of nitinols into the austenite (Af) and martensitic (Mf) phases were studied using differential scanning calorimetry (DSC-3; Mettler Toledo, USA). All indicators were compared with the characteristics of two commercial models-Cronus (China) and E-vita Open Plus (Germany). Results. Four prototypes of SibHybrid stent-grafts were tested; those differed in their stent elements, distances between them, and the type of sutures (single or continuous). The stent elements of the models studied differed in the values of Af, Mf, and the enthalpy of phase transitions of nitinols. The hardest stent was the E2 prototype. The fixation of stent elements to the woven fabric in the graft increased the radial force by 4.0-5.5 times. During compression by 50 and 20% of the original diameter, the SibHybrid models developed radial force 4.5-6.0 times greater compared with the E-vita Оpen Plus model. The radial force values of SibHybrid models were almost the same as for the Cronus and models at 20% compression. Using continuous twining round suturing increased the radial force by about 10 N; accordingly, SibHybrid E2 had the highest radial force because it was fixed by a continuous suture. The density of the stent elements fixed on the fabric did not affect the radial force of the stent-graft as a whole. Conclusion. In the manufacture of stent elements from nitinol tubes, the main factor determining the radial stiffness is the technology of nitinol shape setting. With the standard technology of thermal shape setting, radial force can be changed by varying the height of the structure cell element and the cross-sectional area of the cell bars, as well as the suturing technique.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ab ovo: Factors Affecting the Radial Stiffness of Thoracic Aorta Stent-Grafts

Zhuravleva¹,

Timchenko²,

Vladimirov³

et al. 2021

Sovrem Tehnol Med

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“…The frozen elephant trunk (FET) procedure may be an alternative treatment for these kinds of patients, according to the recent recommendations published by the European Society for Vascular Surgery and the European Association for Cardio-Thoracic Surgery ( 5 , 6 ). The FET procedure combines the advantages of open surgery and endovascular treatment, by which total arch replacement (TAR) and descending aortic dissection repair ( 7 , 8 ) can be performed simultaneously. The FET procedure can eliminate the risk of type Ia endoleak and RTAAD, benefit the thrombosis of false lumen, enable positive aortic remodeling and improve prognosis ( 9 ).…”

Section: Introductionmentioning

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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“…Total aortic arch replacement (TAR) by using the frozen elephant trunk (FET) technique is the standard procedure to treat aortic disease involving repair of the aortic arch and proximal descending thoracic aorta in our hospital [1][2][3] as well as in many aortic centers in the world. [4][5][6][7][8][9][10][11][12] Most recently, an aortic balloon occlusion (ABO) technique was applied to TAR and FET that consistently shortened the lower body circulatory arrest (CA) time and further raised the target nadir temperature setting point for CA. [13] This ABO technique allowed continuous perfusion to 90 abdominal end organs during TAR and FET and eliminated the need for prolonged lower body CA, because it required only 5 minutes (min) on average to set up the 92 ABO device before the lower body CA was ended and the following procedure (the 93 distal aortic anastomosis in TAR and FET) could last as long as needed.…”

Section: Introductionmentioning

confidence: 99%

Risk Factor Analysis of Clinical Outcomes of Total Aortic Arch Replacement and Frozen Elephant Trunk With Aortic Balloon Occlusion

Dun

Wang

2021

Preprint

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Background: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 minutes, which increases the surgical risk. We invented an aortic balloon occlusion technique that requires 5 minutes of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study. Methods: This retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of aortic balloon occlusion group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during the in-hospital stay were also recorded. Results: The 30-day mortality rates were similar between the aortic balloon occlusion group (4.6%) and the conventional group (7.8%, P = 0.241). Multivariate analysis showed aortic balloon occlusion reduced postoperative acute kidney injury (23.1% vs 35.7%, P = 0.013) and hepatic injury (12.3% vs 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge. Conclusions: The aortic balloon occlusion achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay.

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Is the frozen elephant trunk frozen?

Cited by 22 publications

References 28 publications

Ab ovo: Factors Affecting the Radial Stiffness of Thoracic Aorta Stent-Grafts

Ab ovo: Factors Affecting the Radial Stiffness of Thoracic Aorta Stent-Grafts

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

Risk Factor Analysis of Clinical Outcomes of Total Aortic Arch Replacement and Frozen Elephant Trunk With Aortic Balloon Occlusion

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