Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases

Detter, Christian; Demal, T. J.; Bax, L.; Tsilimparis, Nikolaos; Kölbel, Tilo; Kodolitsch, Yskert Von; Vettorazzi, Eik; Reichenspurner, Hermann; Brickwedel, J.

doi:10.1093/ejcts/ezz082

Cited by 41 publications

(62 citation statements)

References 15 publications

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“…The Bologna group noted a postoperative SPI to be higher in those who underwent Z-3-FET versus Z-2-FET (7.5% versus 1.4%, respectively), however, this difference was not significant. 24 A similar outcome was reported by Tsagakis et al, 22 where the rate of paraplegia was reduced to half in the Z-2-FET patients, but in their cohort the difference was also deemed not significant. The same team are also noted that the incidence of stroke resulting in paraplegia are 50% lower with Z-2-FET approach.…”

Section: Spinal Cord Injury (Spi)supporting

confidence: 80%

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

Choudhury

Basharat

Zahra

et al. 2021

Vasc Endovascular Surg

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Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

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Section: Spinal Cord Injury (Spi)supporting

confidence: 80%

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

Choudhury

Basharat

Zahra

et al. 2021

Vasc Endovascular Surg

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“…Preventza et al 6 found that a stent length of 10 cm had a lower risk of spinal cord ischemia, and a stent≥ 15 cm or beyond the T8 should be avoided during the FET operation. Also, the deployment of stent‐graft in Zone 2 can reduce the visceral ischemia time and it is technically easier compared to anastomoses in Zone 3, which can lead to decreased neurological adverse events 25 . We also found in meta‐regression analysis that age was associated with cerebrovascular accidents.…”

Section: Discussionmentioning

confidence: 53%

“…A total of 15 studies reported the number of patients implanted the FET stent with the distal anastomosis in Zones 2 or 3, of which only 3 studies including 660 patients compared outcomes in groups by Zone 2 versus Zone 3 25,46,66 . A total of 282 and 378 patients were implanted the FET stent with the distal anastomosis in Zone 2 and Zone 3, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

et al. 2021

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Background and Aim of the Study The frozen elephant trunk (FET) procedure became a popular entity for utilization in aortic arch aneurysm disease. However, its proper mortality and morbidities as well as the predictors of outcomes are poorly identified. This systematic review and meta‐analysis explore FET outcomes and its predictors with a focus on zone aortic proximalization. Methods We searched PubMed/MEDLINE, EMBASE, and Scopus databases from their beginning to June 2020 to find studies reporting the outcomes of the FET procedure for the total arch replacement (TAR). Results A total of 64 studies including 7967 patients were evaluated. The pooled estimates of cerebrovascular accidents, paraplegia, renal failure, and in‐hospital mortality were 7.104 (95% confidence interval [CI], 5.691–8.661; I2 = 78.53%), 3.465 (95% CI, 2.852–4.136; I2 = 15.96), 14.969 (95% CI, 11.361–18.977; I2 = 91.26%), and 8.933 (95% CI, 7.128–10.919; I2 = 78.51%), respectively. Stratification by the geographical locations and by the aortic pathologies led to lower heterogeneity, but not for renal failure. The distal anastomosis in Zone 2 was associated with a lower rate of renal failure compared with Zone 3 (odds ratio, 0.54; 95% CI, 0.36–0.81; p = .003; I2 = 0%). Conclusions The FET procedure for TAR can be performed with acceptable mortality and morbidities among patients with complex aortic pathologies. Moreover, the distal anastomosis in Zone 2 was associated with lower renal failure compared to Zone 3.

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“…Proximal aortic surgery comprised aortic root replacement procedures including the aortic-valve-sparing techniques according to David or to Yacoub, and composite valve grafting procedures according to Bentall comprising aortic root replacement with a biological valve or with a mechanical valve as described previously [39] ( Table 3). Five of these procedures carried out in Marfan syndrome extended into the aortic arch with usage of a frozen elephant trunk procedure in three as described previously [40] (Table 3). For distal aortic repair we employed open techniques with surgical placement of a prosthesis in the isolated thoracic aortic segment, or in the thoracoabdominal segment, or in the abdominal aorta.…”

Section: Clinical Eventsmentioning

confidence: 99%

Case-matched Comparison of Cardiovascular Outcome in Loeys-Dietz Syndrome versus Marfan Syndrome

Mühlstädt

Backer

Kodolitsch

et al. 2019

JCM

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Background: Pathogenic variants in TGFBR1, TGFBR2 and SMAD3 genes cause Loeys-Dietz syndrome, and pathogenic variants in FBN1 cause Marfan syndrome. Despite their similar phenotypes, both syndromes may have different cardiovascular outcomes. Methods: Three expert centers performed a case-matched comparison of cardiovascular outcomes. The Loeys-Dietz group comprised 43 men and 40 women with a mean age of 34 ± 18 years. Twenty-six individuals had pathogenic variants in TGFBR1, 40 in TGFBR2, and 17 in SMAD3. For case-matched comparison we used 83 age and sex-frequency matched individuals with Marfan syndrome. Results: In Loeys-Dietz compared to Marfan syndrome, a patent ductus arteriosus (p = 0.014) was more prevalent, the craniofacial score was higher (p < 0.001), the systemic score lower (p < 0.001), and mitral valve prolapse less frequent (p = 0.003). Mean survival for Loeys-Dietz and Marfan syndrome was similar (75 ± 3 versus 73 ± 2 years; p = 0.811). Cardiovascular outcome was comparable between Loeys-Dietz and Marfan syndrome, including mean freedom from proximal aortic surgery (53 ± 4 versus 48 ± 3 years; p = 0.589), distal aortic repair (72 ± 3 versus 67 ± 2 years; p = 0.777), mitral valve surgery (75 ± 4 versus 65 ± 3 years; p = 0.108), and reintervention (20 ± 3 versus 14 ± 2 years; p = 0.112). In Loeys-Dietz syndrome, lower age at initial presentation predicted proximal aortic surgery (HR = 0.748; p < 0.001), where receiver operating characteristic analysis identified ≤33.5 years with increased risk. In addition, increased aortic sinus diameters (HR = 6.502; p = 0.001), and higher systemic score points at least marginally (HR = 1.175; p = 0.065) related to proximal aortic surgery in Loeys-Dietz syndrome. Conclusions: Cardiovascular outcome of Loeys-Dietz syndrome was comparable to Marfan syndrome, but the severity of systemic manifestations was a predictor of proximal aortic surgery.

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Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases

Cited by 41 publications

References 15 publications

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

Case-matched Comparison of Cardiovascular Outcome in Loeys-Dietz Syndrome versus Marfan Syndrome

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