A Simplified Delivery Frozen Elephant Trunk Technique to Reduce Circulatory Arrest Time in Hybrid Aortic Arch Surgery: Early Results in a Cohort of 158 Patients

Objective: A simplified delivery technique for the Frozen Elephant Trunk (SD-FET) procedure allows the distal suture to be performed on a perfused and loaded aorta in moderate hypothermia or even normothermia reducing circulatory arrest time to just a few minutes. We compared procedural data and early outcomes of SD-FET to conventional FET approach.

Methods: From December 2016 to August 2021, all patients who underwent an aortic arch replacement with a Thoraflex Hybrid plexus prosthesis (Terumo Aortic, Inchinnan, Scotland, UK) in one of our 6 study centers were included regardless of aortic pathology. Aortic arch replacement was performed either according to the SD-FET technique (short circulatory arrest with body temperature > 32°C) (SD-FET group) or according to the conventional FET technique in deep hypothermia and circulatory arrest (FET group).

Results: Of the 158 patients included, 84 were operated on using the SD-FET and 74 using the FET technique. The cohort was 71% (n = 132) male, the mean age was 63.3 ± 11.3 years and the mean EuroScore II was 7.8 ± 8.3. Underlying pathologies were thoracic aortic aneurysm in 24.7% (n = 39), chronic aortic dissection in 18.3% (n = 29), acute aortic dissections in 57.0% (n = 90) and 8.3% (n = 13) of patients suffered from a connective tissue disorder. Circulatory arrest time was significantly shorter in the SD-FET group (4.4 ± 2.4 vs. 41.2 ± 27.6 minute; p <0.001). In-hospital mortality was 15.3% (n = 24) (11.9% [n = 10] SD-FET group vs. 19.2% [n = 14] FET group; p = 0.21). The rate of post-operative stroke was not different between the groups (9.8% [n = 8] vs. 17.8% [n = 15]; p = 0.14), the rate of spinal cord injury was 3.9% (n = 6) for the whole cohort and was lower in the SD-FET group but does not reach the significance (2.5% [n = 2] vs. 5.5% [n = 4]; p = 0.33). In univariate analysis, significant differences in favor of the SD-FET group, were observed regarding inotropic support duration (16.7 vs. 38.9%; p = 0.002) and a lower peak of lactates in the first 24 hours (p = 0.003).

Conclusion: This SD-FET technique reduces drastically the circulatory arrest with a morbi-mortality comparable to the reference technique. All thoracic aneurysmal pathologies are treatable via the SD-FET procedure although redo surgery is a more difficult indication due to the difficulty to free the aneurysmal aortic arch.

The simplified delivery Frozen Elephant Trunk (A) Placement of the prosthesis in the descending aorta. (B) Stent graft deployment. (C) Full deployment, suture collar facing the aortotomy, then removal of ancillary instruments. (D) Aortic loading via side branch and clamping. (E) The sealing tissue tourniquets are tightened onto a loaded aorta. CPB cardiopulmonary bypass.

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Publikationsverlauf

Artikel online veröffentlicht:
10. Juni 2022