Simplified frozen elephant trunk repair for acute DeBakey type I dissection

Roselli, Eric E.; Rafael, Aldo; Soltesz, Edward G.; Canale, Leonardo Secchin; Lytle, Bruce W.

doi:10.1016/j.jtcvs.2012.11.068

Cited by 105 publications

(79 citation statements)

References 23 publications

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“…The supraaortic vessels may be anastomosed end-to-end to side branches of the graft or as a patch. [6][7][8][9][10][11][12][13] Unfortunately, some delivery systems are quite cumbersome and deployment of the stented portion of the graft might be imprecise, therefore causing a far more distal landing than intended.…”

Section: Introductionmentioning

confidence: 99%

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

et al. 2016

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Aim: To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Methods and results: Between January 2001 and December 2012, 34 patients (mean age 59.9 AE 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 AE 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid-and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. Conclusions: In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up.

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Section: Introductionmentioning

confidence: 99%

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

et al. 2016

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“…As pioneered by Roselli and colleagues, a simplified approach to a frozen elephant trunk has been proposed in the setting of acute type A dissections (26). This involves a modified frozen elephant trunk repair, with an open, antegrade deployment of a TEVAR device into the true lumen of the distal aortic arch under direct visualization.…”

Section: Acute Type a Dissectionsmentioning

confidence: 99%

Hybrid repair of aortic arch aneurysms: a comprehensive review

et al. 2017

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Open total arch replacement (TAR) has become safer with refinements in cerebral protection techniques. The frequent extension of aortic arch aneurysms into the descending thoracic aorta customarily requires a two-staged conventional elephant trunk procedure, carrying relatively high mortality and morbidity risks and high rates of rupture in the interval between the two open surgeries. The technical demands and invasive nature of TAR has therefore precluded many high-risk patients from being surgical candidates for aneurysm repair. As a result, hybrid techniques and approaches to the aortic arch have become common since the adoption of thoracic endovascular aortic repair (TEVAR) and advancement in the commercial grafts that are available. The results of hybrid aortic arch repairs have been encouraging, though with higher rates of re-interventions than TAR and variable reported rates of stroke and spinal cord ischemia.The aim of this publication is to review the current literature on hybrid repair of aortic arch aneurysms.

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“…Because of recent advances in TEVAR and evidence that it results in aortic remodeling and future falselumen thrombosis in patients with aortic dissection in the descending thoracic aorta (36), certain aortic surgery centers have advocated antegrade or retrograde stent delivery in the descending thoracic aorta with simultaneous hemiarch or arch surgery for acute type I aortic dissection (29,31,37). This approach is thought to promote remodeling of the distal aorta and prevent chronic dissecting aneurysm formation that would necessitate additional distal aortic intervention.…”

Section: Treatmentmentioning

confidence: 99%

“…This approach is thought to promote remodeling of the distal aorta and prevent chronic dissecting aneurysm formation that would necessitate additional distal aortic intervention. Reportedly, the additional stent delivery during the procedure is safe, resolves possible malperfusion, and promotes aortic remodeling (29,31,37). Spinal cord ischemia remains a concern with simultaneous antegrade or retrograde stent delivery; thus, stent length is usually 15 cm or less.…”

Section: Treatmentmentioning

confidence: 99%

Differential aspects of ascending thoracic aortic dissection and its treatment: the North American experience

Preventza

Coselli²

2016

Ann. Cardiothorac. Surg.

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Simplified frozen elephant trunk repair for acute DeBakey type I dissection

Abstract: A novel simplified frozen elephant trunk hybrid technique for acute type I dissections allows for safe and effective extended aortic repair with false lumen thrombosis and aortic remodeling of the treated segment. Long-term outcomes of this technique warrant further investigation.

Cited by 105 publications

References 23 publications

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

Hybrid repair of aortic arch aneurysms: a comprehensive review

Differential aspects of ascending thoracic aortic dissection and its treatment: the North American experience

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