“Why is frozen elephant trunk better than classical elephant trunk?”

Marco, Luca Di; Mariani, Carlo; Murana, Giacomo; Amodio, Ciro; Campanini, Francesco; Berardi, Marianna; Leone, Alessandro; Pacini, Davide

doi:10.1007/s12055-021-01302-1

Cited by 5 publications

(2 citation statements)

References 44 publications

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“…This allows the development of a FET (4). The FET technique, which involves a one-stage repair of extensive aortic arch aneurysm by combining the concepts of the classical elephant trunk principle and the endovascular stenting of descending aorta pathology, was introduced in 2003 (5).…”

Section: Introductionmentioning

confidence: 99%

Debranching-first followed by aortic arch replacement with frozen elephant trunk

Suzuki

Akita

Miyazaki

et al. 2023

Preprint

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Background: Diffuse thoracic aortic aneurysm has been a challenge for cardiovascular surgeons as aortic arch and descending aortic aneurysm should be treated simultaneously somehow. The total arch replacement (TAR) using a frozen elephant trunk (FET) allows them to treat aortic arch and descending aortic pathology at once via median sternotomy. Besides, extra-anatomical bypass performed between the left common carotid artery (CCA) and subclavian artery (SCA) prior to TAR allowed further proximalization of FET prosthesis and facilitated distal anastomosis of TAR and spared the demanding Left subclavian artery (LSA) anastomosis in deep pericardial space. We investigated the efficacy of this debranching-first technique followed by total arch replacement using a frozen elephant trunk as a two-stage operation for extensive thoracic aortic aneurysm among high-risk patients. Methods: Forty-nine consecutive patients with diffuse degenerative aneurysms from the aortic arch to the descending aorta or chronic aortic dissection receiving left common carotid to subclavian artery bypass followed by total arch replacement using a frozen elephant trunk and possible subsequent thoracic endovascular aortic repair between 2016 and 2021 were analysed. The baseline characteristics and clinical outcomes were demonstrated. Overall survival rate and 5-year aortic event-free survival, aortic reintervention rates were analysed. Results: The average score of European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was 4.7±2.5. The operative mortality rate was 4.1%, with no paraplegia events. The five-year overall survival, cumulative aortic related mortality were 76.8%, 2%, respectively. The five-year overall cumulative aortic reintervention rates including intended intervention were 31.3%. The 5-year cumulative rate of non-intended reintervention was 4.5%. Conclusions: The assessed technique enables a less invasive and less technically demanding surgery with reasonable outcomes. The 5-year aortic event-free survival and reintervention rates were acceptable, suggesting that multiple stages of alternative open and endovascular interventions, such as this technique, may reduce the morbidity and mortality rates of high-risk patients with diffuse thoracic aortic aneurysm. Clinical registration number: 2022001

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Section: Introductionmentioning

confidence: 99%

Debranching-first followed by aortic arch replacement with frozen elephant trunk

Suzuki

Akita

Miyazaki

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…This allows the development of FET [ 4 ]. The FET technique, which involves a one-stage repair of extensive aortic arch aneurysms by combining the concepts of the classical elephant trunk principle and endovascular stenting of descending aorta pathology, was introduced in 2003 [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Extra-anatomical left common carotid and subclavian artery bypass followed by aortic arch replacement with frozen elephant trunk

Suzuki,

Akita,

Miyazaki

et al. 2023

J Cardiothorac Surg

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Background Total arch replacement (TAR) using a frozen elephant trunk (FET) allows for simultaneous treatment of the aortic arch and descending aortic pathology via median sternotomy. In addition, an extra-anatomical bypass performed between the left common carotid artery (CCA) and subclavian artery (SCA) prior to TAR allowed further proximalisation of the FET prosthesis, facilitated distal anastomosis of the TAR and spared the demanding left subclavian artery (LSA) anastomosis in the deep thorax. We investigated the efficacy of this debranching-first technique, followed by TAR using a frozen elephant trunk, as a two-stage operation for extensive thoracic aortic aneurysms in high-risk patients. Methods Forty-nine consecutive patients with diffuse degenerative aneurysms from the aortic arch to the descending aorta or chronic aortic dissection who underwent left common carotid to subclavian artery bypass followed by TAR using a frozen elephant trunk and subsequent thoracic endovascular aortic repair between 2016 and 2021 were analysed. The baseline characteristics and clinical outcomes were assessed. The estimated overall survival, 5-year aortic event-free survival, and aortic reintervention rates were analysed. Results The average European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was 4.7 ± 2.5. The operative mortality rate was 4.1%, with no paraplegia events. The estimated 5-year overall survival, cumulative aortic-related mortality rates were 76.8% and 2%, respectively. The estimated 5-year overall cumulative aortic reintervention rate, including the intended intervention, was 31.3%. The estimated 5-year cumulative rate of non-intended reintervention was 4.5%. Conclusions The assessed technique enables a less technically demanding surgery with reasonable outcomes. The estimated 5-year aortic event-free survival and reintervention rates were acceptable, suggesting that multiple stages of alternative open and endovascular interventions, such as this technique, may reduce the morbidity and mortality rates of high-risk patients with diffuse thoracic aortic aneurysm. UMIN-CTR (University hospital Medical Information Network-Clinical Trial Registry) https://center6.umin.ac.jp/cgi-open-bin/ctr_e/index.cgi Clinical registration number: UMIN000051531

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