CC BY 4.0 · Aorta (Stamford) 2018; 06(06): 125-129
DOI: 10.1055/s-0039-1677809
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections

Luis F. López Almodóvar
1   Department of Cardiac Surgery, Virgen de la Salud Hospital, Toledo, Spain
,
Pedro Lima Cañadas
1   Department of Cardiac Surgery, Virgen de la Salud Hospital, Toledo, Spain
,
Andrés Enríquez Puga
2   Department of Radiology, Virgen de la Salud Hospital, Toledo, Spain
,
Irene Narváez Mayorga
3   Department of Cardiology, Virgen de la Salud Hospital, Toledo, Spain
,
José A. Buendía Miñano
1   Department of Cardiac Surgery, Virgen de la Salud Hospital, Toledo, Spain
,
Marcelino Sánchez Casado
4   Department of Intensive Care Unit, Virgen de la Salud Hospital, Toledo, Spain
,
Alfonso Cañas Cañas
1   Department of Cardiac Surgery, Virgen de la Salud Hospital, Toledo, Spain
› Author Affiliations
Funding None.
Further Information

Publication History

15 July 2017

05 November 2018

Publication Date:
24 April 2019 (online)

Abstract

Background Acute Type A aortic dissection (AAAD) is a surgical emergency. In patients with arch and descending aorta involvement (DeBakey Type I), a total aortic arch replacement with frozen elephant trunk (FET) could favor false lumen thrombosis and improve long-term results. The authors hereby present their experience with this technique in a single low-volume center, to assess whether the technique is feasible to treat such disease.

Methods From January 2011 to December 2016, 43 patients with AAAD were operated on in the authors' institution, which carries out 300 to 350 annual procedures. Among these, 12 patients with an intimal tear in the aortic arch and/or proximal descending aorta received a FET procedure (10 males, age 57 years). Concomitant procedures were aortic valve replacement (42%), Bentall (25%), and aortic valve repair (17%).

Results Cardiopulmonary bypass, cardiac arrest, and circulatory arrest times were 235 ± 43, 171 ± 33, and 75 ± 20 minutes, respectively. The operative mortality was 16.7% (n = 2). Stroke and re-thoracotomy for bleeding occurred in 8% (n = 1) and 8% (n = 1), respectively. There was no spinal cord injury. Follow-up was 36.1 months. During follow-up, no patients died or required a reoperation on the downstream aorta.

Conclusion Although all patients were operated on in a low-volume center, the results with FET in AAAD are acceptable. Even though this technique demands high technical skills, it is a promising approach in patients with acute aortic dissection.

 
  • References

  • 1 Bonser RS, Ranasinghe AM, Loubani M. , et al. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol 2011; 58 (24) 2455-2474
  • 2 Smith HN, Boodhwani M, Ouzounian M. , et al. Classification and outcomes of extended arch repair for acute type A aortic dissection: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2017; 24 (03) 450-459
  • 3 Tian DH, Wan B, Di Eusanio M, Black D, Yan TD. A systematic review and meta-analysis on the safety and efficacy of the frozen elephant trunk technique in aortic arch surgery. Ann Cardiothorac Surg 2013; 2 (05) 581-591
  • 4 Li D, Ye L, He Y. , et al. False lumen status in patients with acute aortic dissection: a systematic review and meta-analysis. J Am Heart Assoc 2016; 5 (05) e003172
  • 5 Shrestha M, Fleissner F, Ius F. , et al. Total aortic arch replacement with frozen elephant trunk in acute type A aortic dissections: are we pushing the limits too far?. Eur J Cardiothorac Surg 2015; 47 (02) 361-366 , discussion 366
  • 6 Pacini D, Tsagakis K, Jakob H. , et al. The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: a multicenter experience. Ann Thorac Surg 2011; 92 (05) 1663-1670 , discussion 1670
  • 7 Tsagakis K, Pacini D, Di Bartolomeo R. , et al. Multicenter early experience with extended aortic repair in acute aortic dissection: is simultaneous descending stent grafting justified?. J Thorac Cardiovasc Surg 2010; 140 (6, Suppl): S116 –S120, discussion S142–S146
  • 8 Czerny M, Rylski B, Kari FA. , et al. Technical details making aortic arch replacement a safe procedure using the Thoraflex™ Hybrid prosthesis. Eur J Cardiothorac Surg 2017; 51 (Suppl. 01) i15-i19
  • 9 Mestres CA, Tsagakis K, Pacini D. , et al; IEOR Registry Group. One-stage repair in complex multisegmental thoracic aneurysmal disease: results of a multicentre study. Eur J Cardiothorac Surg 2013; 44 (05) e325-e331
  • 10 Tsagakis K, Dohle D, Benedik J, Lieder H, Jakob H. Overall Essen's experience with the E-vita open hybrid stent graft system and evolution of the surgical technique. Ann Cardiothorac Surg 2013; 2 (05) 612-620
  • 11 Kazui T, Washiyama N, Muhammad BA. , et al. Extended total arch replacement for acute type a aortic dissection: experience with seventy patients. J Thorac Cardiovasc Surg 2000; 119 (03) 558-565
  • 12 Leontyev S, Tsagakis K, Pacini D. , et al. Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: results of a multicentre study. Eur J Cardiothorac Surg 2016; 49 (02) 660-666
  • 13 Leontyev S, Borger MA, Etz CD. , et al. Experience with the conventional and frozen elephant trunk techniques: a single-centre study. Eur J Cardiothorac Surg 2013; 44 (06) 1076-1082 , discussion 1083
  • 14 Di Bartolomeo R, Murana G, Di Marco L. , et al. Frozen versus conventional elephant trunk technique: application in clinical practice. Eur J Cardiothorac Surg 2017; 51 (Suppl. 01) i20-i28
  • 15 Dohle DS, Tsagakis K, Janosi RA. , et al. Aortic remodelling in aortic dissection after frozen elephant trunk. Eur J Cardiothorac Surg 2016; 49 (01) 111-117
  • 16 Jakob H, Dohle D, Benedik J. , et al. Long-term experience with the E-vita Open hybrid graft in complex thoracic aortic disease. Eur J Cardiothorac Surg 2017; 51 (02) 329-338
  • 17 Katayama A, Uchida N, Katayama K, Arakawa M, Sueda T. The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience. Eur J Cardiothorac Surg 2015; 47 (02) 355-360 , discussion 360
  • 18 Shrestha M, Bachet J, Bavaria J. , et al. Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the vascular domain of EACTS. Eur J Cardiothorac Surg 2015; 47 (05) 759-769
  • 19 Shrestha M, Haverich A, Martens A. Total aortic arch replacement with the frozen elephant trunk procedure in acute DeBakey type I aortic dissections. Eur J Cardiothorac Surg 2017; 51 (Suppl. 01) i29-i34
  • 20 Bashir M, Shaw M, Field M. , et al. Repair of type A dissection—benefits of dissection rota. Ann Cardiothorac Surg 2016; 5 (03) 209-215