The risk of spinal cord injury during the frozen elephant trunk procedure in acute aortic dissection

Kozlov, B. N.; Panfilov, D. S.; Ponomarenko, I. V.; Miroshnichenko, A. G.; Nenakhova, Aleksandra A; Maksimov, A. I.; Shipulin, V. M.

doi:10.1093/icvts/ivx432

Cited by 19 publications

(14 citation statements)

References 11 publications

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“…Of 64 studies reporting outcomes of patients included in this report 13–76 . The proportions of studies from Asia, Europe, and North America were 54.7%, 31.3%, and 10.9%, respectively.…”

Section: Methodsmentioning

confidence: 99%

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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“…Of 64 studies reporting outcomes of patients included in this report 13–76 . The proportions of studies from Asia, Europe, and North America were 54.7%, 31.3%, and 10.9%, respectively.…”

Section: Methodsmentioning

confidence: 99%

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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“…However, TAR-FET for AAAD could be complicated with spinal cord injury (SCI) [ 10 – 12 ]. SCI is one of the most devastating complications of TAR-FET [ 13 ], and survival rates among patients with paraplegia are significantly lower than those among the able-bodied patients [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Early and mid-term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aortic dissection

Hohri

Yamasaki

Matsuzaki

et al. 2020

Gen Thorac Cardiovasc Surg

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Objective This study aimed to evaluate the prevalence of spinal cord injury in total arch replacement with frozen elephant trunk for acute type A aortic dissection using our spinal cord protection technique. Methods Between January 2013 and December 2017, 33 patients underwent total arch replacement with frozen elephant trunk for acute type A aortic dissection (mean age 67.9 ± 13.3 years). Our spinal cord protection technique involved maintaining extracorporeal circulation through the left subclavian artery in all procedures, using aortic occlusion balloon during distal anastomosis, and inserting frozen elephant trunk above Th 8 with transesophageal echocardiographic guidance. Computed tomography was performed within 1–2 weeks, 12 months, and 36 months postoperatively. We compared the degree of thrombosis of the descending aorta between preoperation and early postoperative period by Fisher’s exact test. Moreover, we evaluated postoperative mortality and mobility (including spinal cord injury) at follow-up. Results The operative mortality within 30 days was 6.1%. Neither paraplegia nor paraparesis was noted. We observed significant thrombosis of the false lumen at the distal arch and aortic valve level of the descending aorta in postoperative early term period (p < 0.01). At mid-term follow-up (mean 33.9 months), survival probability and 3-year freedom from reoperation rates were 93.9 ± 4.1% and 95.0 ± 4.9%, respectively. Conclusions The frozen elephant trunk technique with our spinal protection strategy provides good postoperative outcomes. Our strategy can maintain spinal cord perfusion without complete ischemia time even during lower body ischemia time. Implementation of our spinal protection strategy will help prevent spinal cord injury and dilated downstream aorta.

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“…The use of cerebrospinal fluid drainage is not explicitly endorsed by the European position paper 6 ; however, it may help reduce the rate of postoperative paraplegia, which is a well-established risk of FET approaches to aortic arch repair. [8][9][10] Leone and colleagues 7 also described in detail the difference in operative strategies between the European centers of interest, Bologna University and Hannover medical school. For instance, Bologna University provided antegrade cerebral perfusion by using a variety of cannulation sites (such as the right axillary, femoral, innominate, or right carotid arteries) as well as direct cannulation of the ascending aorta, whereas Hannover Medical School commonly provided bilateral antegrade cerebral perfusion using the left carotid and innominate arteries.…”

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confidence: 99%

Commentary: Despite global warming, frozen has its place

Coselli

2020

The Journal of Thoracic and Cardiovascular Surgery

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The risk of spinal cord injury during the frozen elephant trunk procedure in acute aortic dissection

Cited by 19 publications

References 11 publications

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

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

Early and mid-term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aortic dissection

Commentary: Despite global warming, frozen has its place

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