Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Preventza, Ourania; Liao, Jane; Olive, Jacqueline K.; Simpson, Keith; Critsinelis, Andre C.; Price, Matt D.; Galati, Marianne; Cornwell, Lorraine D.; Orozco-Sevilla, Vicente; Omer, Shuab; Jiménez, Ernesto; LeMaire, Scott A.; Coselli, Joseph S.

doi:10.1016/j.jtcvs.2019.10.031

Cited by 181 publications

(158 citation statements)

References 51 publications

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“…Although this surgical approach is considered a major surgery with substantial morbidity and mortality, FET currently represents the treatment of choice in many institutions. The hybrid graft can be applied in a wide variety of aortic arch pathologies with very few restrictions regarding aortic arch anatomy, including aortic emergencies (2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Results of frozen elephant trunk from the international E-vita Open registry

Tsagakis¹,

Pacini²,

Grabenwöger³

et al. 2020

Ann Cardiothorac Surg

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Background: Over the years, frozen elephant trunk (FET) has become the treatment of choice for multisegmental thoracic aortic disease. This multicenter study presents the evolution of FET results using the E-vita Open hybrid graft with respect to institutional experience and time. Methods: The data of International E-vita Open registry were studied according to the institutional experience of the participating centers (high-versus low-volume centers) and according to the evolution of FET treatment during time (1 st period, 2005-2011 versus 2 nd period, 2012-2018). Overall, 1,165 patients were enrolled in the study with a wide variety of multisegmental thoracic aortic pathologies and aortic emergencies. Participating centers determined their own surgical protocol. Results: The overall 30-day mortality was 12%. Short-and long-term survival were higher in high-versus low-volume centers (P=0.048 and P=0.013, respectively). In the 2 nd time period, cerebral complications were reduced significantly (P=0.015). Incidence of permanent spinal cord-related symptoms was reduced to 3% in the 2 nd time period, but did not reach statistical significance. Hypothermic circulatory arrest time (P<0.001) and incidence of postoperative temporary renal replacement therapy (P=0.008) were significantly reduced in the 2 nd time period. Ten-year survival and freedom from aortic-related death rates were 46.6% and 85.7%, respectively, for the entire group. The freedom from distal aortic re-interventions for a new or progressive residual aortic disease was 76.0%. Conclusions: Evolution of FET arch repair techniques with the E-vita Open graft and increasing institutional experience were associated with improved results. Progression of residual aortic disease makes close follow-up with aortic imaging mandatory in such patients.

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Section: Introductionmentioning

confidence: 99%

Results of frozen elephant trunk from the international E-vita Open registry

Tsagakis¹,

Pacini²,

Grabenwöger³

et al. 2020

Ann Cardiothorac Surg

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“…Permanent stroke and especially spinal cord ischemia are the most feared and devastating. In a recent meta‐analysis, Preeventza et al 22 analyze the pooled outcome of 3154 patients from 35 studies who underwent an FET procedure. In‐hospital mortality was 8.8%, and permanent stroke and spinal cord injury (SCI) rates were 7.6% and 4.7%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Single‐center experience and evolution of technique with the E‐vita Open prosthesis

et al. 2020

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Background We report our experience in aortic arch repair with the E‐vita Open hybrid prosthesis and describe the changes in our technique over time. Methods Between October 2013 and December 2019, 56 patients underwent a total aortic arch replacement with the E‐vita Open hybrid prosthesis. The main indications were thoracic aorta aneurysm (n = 27) and acute type A aortic dissection (n = 18). We analyze the technique and results in the overall series, and compare both between our early (group I, 25 patients) and late experience (group II, 31 patients). Results Overall in‐hospital mortality was 7.1% (n = 4), and permanent stroke and spinal cord injury were 3.6% and 1.8%, respectively. Fifteen patients (26.8%) underwent a planned second procedure on the distal aorta: 13 endovascular, 1 open, and 1 hybrid. Survival at 1 and 3 years was 90.7% and 80.7%, respectively. Group II included more patients with acute dissection (45.2% vs 16%, P = .02), higher rates of bilateral cerebral perfusion (100% vs 64%, P < .001), left subclavian artery perfusion during lower body circulatory arrest (87.1% vs 0%, P < .001), early reperfusion (96.8% vs 40%, P < .001), and zone 0 to 2 distal anastomosis (100% vs 72%, P = .02). In‐hospital mortality (3.2% vs 12%) and permanent stroke (0% vs 8%) tended to be lower in group II. Conclusions Total arch replacement with E‐vita Open hybrid prosthesis in complex thoracic aorta disease is safe. One‐stage treatment is feasible when pathology does not extend beyond the proximal descending thoracic aorta. In any case, it facilitates subsequent procedures on distal aorta if needed.

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“…This can be mitigated by using shorter stents and setting the arch anastomosis more proximally (zone 2). 36…”

Section: Off-the-shelf Hybrid Fet Devicesmentioning

confidence: 99%