Short- and midterm results after hybrid treatment of chronic aortic dissection with the frozen elephant trunk technique

Eusanio, Marco Di; Armaro, Alessandro; Marco, Luca Di; Pacini, Davide; Savini, Carlo; Suàrez, Sofia Martìn; Bartolomeo, Roberto Di

doi:10.1016/j.ejcts.2011.01.068

Cited by 25 publications

(25 citation statements)

References 18 publications

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“…The prognosis of patients after surgery is closely related to the condition of false lumen thrombosis [22]. Several previous studies have revealed that false lumen patency was related to progressive aortic dilation, while total obliteration of the false lumen might prevent aneurysm formation [10,23–25].…”

Section: Discussionmentioning

confidence: 99%

Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Luo

Tang

et al. 2017

Med Sci Monit

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BackgroundSun’s procedure is a surgical technique widely used in type A aortic dissection. The purpose of this study was to analyze clinical outcomes and morphologic changes in true and false lumen by computed tomography (CT) angiography after Sun’s procedure.Material/MethodsWe retrospectively reviewed 51 patients who underwent Sun’s procedure for acute Stanford type A aortic dissection extending down to iliac bifurcation between January 2013 and December 2014. The images of preoperative, one-month, three-month, and six-month follow-up were analyzed by CT angiography to measure the area and diameter of true and false lumen.ResultsFour patients died before surgical intervention and postoperative deaths occurred in five patients (in-hospital mortality rate 10.6%). Only 42 patients (36 male, 6 female; mean age, 45.9±9.8 years; range, 24–65 years) with acute type A aortic dissection were involved in our study. Thirty-five patients (83.3%) suffered from chest or abdominal pain and only one patient (2.4%) was asymptomatic. Thirty-seven patients (88.1%) had hypertension as the most common comorbidity. In the ascending aorta, false lumen was eliminated and the change of true lumen was not significant (p>0.05). In the descending aorta, complete and partial thrombosis of false lumen were observed in eight patients (19.0%) and 33 patients (78.6%) by one-month follow-up CT scan, respectively. After the six-month follow-up, the rate of complete thrombosis increased to 36.1% and partial thrombosis decreased to 61.9%. The area and maximal diameter of true lumen were increased significantly (p<0.05), whereas significant decreases were found in the area and maximal diameter of false lumen (p<0.05). In the abdominal aorta, thrombosis was found in 52.4% patients at one-month follow-up CT. Furthermore, there were no significant changes in both true and false lumen within three months (p>0.05). Nevertheless, the false luminal area and maximal diameter decreased significantly (p<0.05) after six months, while these changes of true lumen were not significant (p>0.05).ConclusionsAfter Sun’s procedure, aortic remodeling was a continuous process and occurred in a predictable model, and the extent of aortic remodeling varied at different levels. Remodeling in descending thoracic aorta was earlier than it was in abdominal aorta.

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Section: Discussionmentioning

confidence: 99%

Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Luo

Tang

et al. 2017

Med Sci Monit

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“…[14][15][16][17][18] Among patients with chronic dissection treated with the frozen elephant technique, early mortality in the 4 largest reported series has ranged from 1.1% to 15.5%. [19][20][21][22] Sun and colleagues 19 reported an early mortality rate of 1.1% for 89 patients. However, patients with aneurysms measuring 5 cm or greater were excluded from the frozen elephant trunk procedure in this study.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] In the published series of patients undergoing hybrid debranching procedures involving the aortic arch, where patients with chronic aortic dissection were analyzed separately, the early mortality for this subset ranged from 3% to 17%. [23][24][25] With regard to postoperative morbidity, the prevalence of stroke and renal failure requiring dialysis in the present study did not exceed that reported from the series of patients undergoing the frozen elephant trunk procedure (2.2% to 9.8% and 12% to 22%, respectively), [19][20][21][22] or the hybrid procedure (3% to 8% and 0% to 11%, respectively). [23][24][25] The relatively high prevalence of pulmonary dysfunction in our series of patients, as evidenced by the need for prolonged intubation and tracheostomy, has been considered to be a limitation of the 1-stage procedure.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and rates of aortic growth and reoperation after 1-stage repair of extensive chronic thoracic aortic dissection

Kouchoukos

Kulik

Castner

2018

The Journal of Thoracic and Cardiovascular Surgery

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Our extended experience with the 1-stage open procedure confirms its safety and durability for treatment of chronic aortic dissection with enlargement confined to the thoracic aorta. The procedure is associated with low operative risk and a low incidence of reoperation on the contiguous aorta. It represents a suitable alternative to the 2-stage, frozen elephant trunk, and hybrid procedures that are also used to treat this condition.

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“…Results from several large series of patients in whom this technique has been used have recently been reported. 17,[20][21][22] They have shown early mortality rates ranging from 1.4% to 13%, stroke rates of 1% to 6%, and most concerning, spinal cord ischemic injury rates of between 3% and 10%. Renal failure requiring dialysis occurred in 1.4% to 20% of patients, and prolonged ventilatory support was required in 12% to 31% of patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and fate of the distal aorta following 1-stage repair of extensive chronic thoracic aortic dissection

Kouchoukos

Kulik

Castner

2013

The Journal of Thoracic and Cardiovascular Surgery

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Short- and midterm results after hybrid treatment of chronic aortic dissection with the frozen elephant trunk technique

Abstract: The frozen elephant trunk technique, allowing treatment of extensive disease of the thoracic aorta, was associated with encouraging short- and midterm results. Longer-term follow-up is warranted.

Cited by 25 publications

References 18 publications

Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Clinical outcomes and rates of aortic growth and reoperation after 1-stage repair of extensive chronic thoracic aortic dissection

Clinical outcomes and fate of the distal aorta following 1-stage repair of extensive chronic thoracic aortic dissection

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