Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years†

Shrestha, Malakh; Martens, Andreas; Kaufeld, Tim; Beckmann, Erik; Bertele, Sebastian; Krueger, Heike; Neuser, Julia; Fleißner, Felix; Ius, F.; Alhadi, Firas Abd; Hanke, Jasmin S.; Schmitto, Jan D.; Cebotari, Serghei; Kretzler, Matthias; Haverich, Axel; Chavan, Ajay

doi:10.1093/ejcts/ezx218

Cited by 125 publications

(119 citation statements)

References 17 publications

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“…A recent study has found that at the time of initial repair for TAAD in MFS, a more aggressive surgical approach seems to be superior to limited repair (29). However, there is scarce data on the long-term outcomes of such extensive repair for TAAD in such patients (19,22,30). The current cohort expanded the special subset of MFS patients in our experience (17,22,31), who, following a prior Bentall procedure, developed TAAD involving the arch, which was repaired in a reoperative setting with the extensive FET technique.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, reoperation for arch dissection was required in 40.9-49% of patients (15,16). As a result, the more extensive total arch replacement (TAR) (15) or in combination with the frozen elephant trunk (FET) has been advocated as an approach to TAAD involving the aortic arch in patients with MFS during initial surgical treatment (17)(18)(19), despite concerns on the mortality and paraplegia risks and limited imaging follow-up (20,21). Although our previous study has proved the efficacy and durability of TAR + FET for TAAD in MFS (22), data is scarce regarding the longterm outcomes of this technique for TAAD in Marfan patients who have undergone a Bentall operation previously.…”

Section: Introductionmentioning

confidence: 99%

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Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome

Chen

Zheng

et al. 2018

J. Thorac. Dis.

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Background: We seek to report the long-term outcomes of the total arch replacement and frozen elephant trunk (TAR + FET) technique for type A aortic dissection (TAAD) following prior Bentall procedure in patients with Marfan syndrome (MFS). Methods: Between 2003 and 2015, we performed TAR + FET for 26 patients with MFS who developed TAAD following a prior Bentall procedure. Mean age at FET 36.9±9.7 years and 24 were males. TAAD was acute in 8 (30.8%, all new dissections from precious root aneurysm) and chronic in 18 (69.2%, 15 residual and 3 new). The interval from Bentall procedure to FET averaged 6.4±5.8 years, which was significantly longer in the acute group (10.3±6.3 vs. 4.6±4.9, P=0.021). The early and long-term outcomes were compared between two groups and risk factors identified for late adverse events.Results: Operative mortality was 11.5% (3/26). Stroke, lower limb ischemia and reexploration for bleeding occurred in 1 patient each (3.8%). Follow-up was complete in 100% (23/23) at mean 5.1±2.3 years (range, 0.9-11.2 years). The maximal diameter (DMax) of distal aorta in the chronic group was significantly greater at the unstented descending aorta [DA, (56.4±15.5 vs. 35.6±12.2 mm, P=0.006)] compared to acute patients. The false lumen was obliterated in 95.7% across the FET and 56.5% in the unstented DA. Distal aortic dilation occurred in 13 patients (11 chronic, 68.8%). Of those 11 patients, 4 underwent an open thoracoabdominal aortic repair and 3 died of distal aortic rupture. Late death occurred in 7 patients at mean 3.9±2.5 years. At 6 years, the incidence was 18% for death, 11% for distal aortic reoperation, and 71% for reoperationfree survival. Survival did not differ between two groups (75.0% vs. 71.3%, P=0.851), while acute patients had significantly higher freedom from late rupture and reoperation at 6 years (100% vs. 61.9%, P=0.046). Bentall procedure in patients with MFS. Early and late survival did not differ with acute and chronic dissections, while freedom from late rupture and reoperation is significantly higher in patients with acute TAAD. Patients with hypertension and aged <35 years are at higher risk for late distal aortic dilation, reoperation and death.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome

Chen

Zheng

et al. 2018

J. Thorac. Dis.

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“…Thus, our results confirmed that the need for reintervention is due to the characteristics of the primary disease, and not because of the failure of FET's prosthesis. Besides, FET simplified reintervention in the distal segments, providing a more appropriate landing zone for endovascular completion …”

Section: Discussionmentioning

confidence: 99%

The learning curve effect on outcomes with frozen elephant trunk technique for extensive thoracic aorta disease

et al. 2019

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Objective The purpose of this study was to analyze the learning curve effect on hospital mortality, postoperative outcomes, freedom from reintervention in the aorta and long‐term survival after frozen elephant trunk (FET) operation. Methods From July 2009 to June 2018, 79 patients underwent surgery with the FET technique. They had type A aortic dissection (acute 7.6%, chronic 33%), type B aortic dissection (acute 1.26%, chronic 34.2%), and complex thoracic aortic aneurysm (24%). 27.8% were reoperations and 43% received concomitant cardiac procedures. To compare the results, the sample was divided into group 1 (G1) (first half of the sample ‐ operations from 2009 to 2014) and group 2 (G2) (first half of the sample ‐ operations from 2015 to 2018). Results The in‐hospital mortality was 20.25%, 30.7% for G1 and 10% for G2 (P = .02). The mean cardiopulmonary bypass time, myocardial ischemia time, and selective cerebral perfusion at 25°C time were 154 ± 31, 118 ± 32, and 59 ± 12 minutes, respectively, similar for both groups. Stroke and spinal cord injury occurred in four and two patients, with no difference between groups (P = .61 and P = .24). The necessity for secondary intervention on the downstream aorta for both groups was also similar (P = .136). Five of sixty‐three surviving patients died during the follow‐up period and the estimated survival rate was different between groups 49% vs 88% (P = .007). Conclusion The learning curve with the FET procedure had a significant impact on hospital mortality and midterm survival over the follow‐up period, albeit did not influence the freedom from reintervention on the downstream aorta.

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“…In particular the false lumen in the descending aorta thromboses in a large proportion of patients, reducing the risk for further late distal malperfusion syndromes. Several groups have, indeed, published quite satisfactory results with the use of this method, in particular after surgery for acute or chronic aortic dissection (43)(44)(45)(46).…”

Section: The "Frozen Elephant Trunk" Techniquementioning

confidence: 99%

Open repair techniques in the aortic arch are still superior

Bachet¹

2018

Ann. Cardiothorac. Surg.

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Conventional arch replacement can be carried out in a great majority of patients. Hybrid procedures are often as invasive and technically difficult as conventional ones. Moreover, their immediate results are, in many reported experiences, not better and their long-term results less favourable than the ones observed with conventional methods. So, yes, the open conventional arch replacement is still "the gold standard".

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Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years†

Abstract: FET results are comparable with those of the published results of the conventional elephant trunk technique. FET is an ideal landing zone for subsequent transfemoral endovascular completion. Patients with graft infections may have dismal results.

Cited by 125 publications

References 17 publications

Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome

Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome

The learning curve effect on outcomes with frozen elephant trunk technique for extensive thoracic aorta disease

Open repair techniques in the aortic arch are still superior

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