Multimodality imaging assessment for Thoraflex hybrid total arch replacement

Abstract

Conventionally, aortic pathologies involving the ascending, arch, and descending thoracic aorta are treated by a staged operation. The Thoraflex device is a composite 4-branched graft with a distal endovascular stent, which allows one-stage treatment of these pathologies. We describe our multimodality hybrid approach for total arch replacement using the Thoraflex device with the adjunct of intraoperative 3-dimensional transesophageal echocardiography, Endo-EYE endoscopy, and on-table aortography in a hybrid operating room. These multimodality assessments can ascertain adequate sealing of a distal aortic tear and proper opening of the endograft, and provide on-table functional assessment of false lumen hemodynamics. Early results are promising.

Endovascular Fenestration for Distal Aortic Sealing After Frozen Elephant Trunk With Thoraflex

“…A 53-year-old man presented to us with Stanford type B aortic dissection with a distal aortic arch aneurysm measuring a maximum of 7.8 cm in the short axis diameter. Total arch replacement with FET with use of the Thoraflex hybrid device (Vascutek, Terumo, Scotland) was performed with the technique we previously described [1]. The FET part of the Thoraflex hybrid device was deployed into the true lumen, and a satisfactory opening was confirmed by intraoperative transesophageal echocardiography.…”

Launching the E‐vita Open Neo amid COVID—Challenges and strategies

“…Our institute adopted an arch branched graft version of E‐vita Open Neo. The approach of our TAR FET technique was previously reported, principally with the distal‐proximal‐supra‐aortic sequence of anastomosis under moderate hypothermic circulatory arrest and selective antegrade cerebral perfusion to all supra‐aortic vessels 17 . The distance between the sewing collar and the third (left subclavian artery) side branch of the E‐vita Open Neo was 20 mm when compared with that of 5 mm in Thoraflex™ hybrid stent graft, which provides longer anastomosis space to left subclavian artery and lowers the risk of graft kinking.…”

Current management of acute aortic syndrome

“…). The simultaneous correction of downstream malperfusion syndrome with the help of frozen elephant trunk, and the use of on‐table multimodality imaging to identify the false lumen haemodynamics and guide the deployment of the frozen elephant trunk, might be the contributing factors …”