Devising a technique for distal anastomosis during total arch replacement using the frozen elephant trunk technique: reverse stepwise anastomosis

2018 ◽  
Vol 66 (8) ◽  
pp. 492-494
Author(s):  
Hidenori Sako ◽  
Hideyuki Tanaka ◽  
Masato Morita ◽  
Tetsushi Takayama
Keyword(s):  
Distal Anastomosis ◽  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Open distal anastomosis in the frozen elephant trunk technique: initial experiences and preliminary results of arch zone 2 versus arch zone 3†

2019 ◽  
Vol 56 (3) ◽  
pp. 564-571 ◽  
Author(s):  
Alessandro Leone ◽  
Luca Di Marco ◽  
Giuditta Coppola ◽  
Ciro Amodio ◽  
Marianna Berardi ◽  
...  
Keyword(s):  
Injury Rate ◽  
Distal Anastomosis ◽  
Neurological Dysfunction ◽  
Control Group ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Ischaemia Time ◽  
Elephant Trunk Technique ◽  
Aortic Dissections ◽  
Frozen Elephant Trunk Technique

Abstract OBJECTIVES We compared the results of 2 groups of patients who underwent aortic arch replacement with the frozen elephant trunk technique. In the first group, the distal anastomosis was performed in arch zone 2; in the second control group, the distal anastomosis was performed in arch zone 3. METHODS Between January 2007 and April 2018, the frozen elephant trunk technique was used in 282 patients. The median age was 62 years (range 18–83 years), and 233 patients were men (82.6%). Two different frozen elephant trunk prostheses were used: the Jotec E-vita open prosthesis in 167 patients (59.2%) and the Vascutek Thoraflex hybrid prosthesis in 115 patients (40.8%). Patients were divided into 2 groups according to the distal anastomosis site: zone 2 group (69 patients) and zone 3 group (213 patients). The main indications were chronic aortic dissection (n = 164, 58.2%), degenerative aneurysm (n = 72, 25.5%) and acute aortic dissections (n = 45, 16%). RESULTS The overall in-hospital mortality rate was 17%: 20% for the zone 2 group and 16% for the zone 3 group, without significant differences, also in terms of cardiopulmonary bypass and myocardial ischaemia times. However, the visceral ischaemia time was significantly shorter for the zone 2 group, whereas the antegrade selective cerebral perfusion time was significantly longer for the same group. Recurrent laryngeal nerve injury rate was lower in the zone 2 group. The overall postoperative paraplegia rate was 3.5%, whereas the occurrence of permanent neurological dysfunction and dialysis was 9% and 19%, respectively, with no significant differences between the groups. CONCLUSIONS ‘Proximalization’ of the distal anastomosis can be used for arch reconstruction, especially in complex cases such as reoperations or acute aortic dissections. Furthermore, with the aid of branched hybrid grafts, a reduction of the visceral ischaemia time is achieved.

Pre-emptive BioGlue priming of the branched Evita Open NEO hybrid prosthesis: tackling excessive oozing

2021 ◽  
Author(s):  
Jacky Y K Ho ◽  
Kevin Lim ◽  
Takuya Fujikawa ◽  
Randolph H L Wong
Keyword(s):  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Hybrid Prosthesis ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract Excessive oozing after total arch replacement with the frozen elephant trunk technique through the fabric of the E-vita Open NEO raised concern about its early adaptation. The mechanism is speculated to be multifactorial. Our goal was to report our approach using pre-emptive BioGlue priming on the fabric against the oozing phenomenon.

scholarly journals Total arch replacement with bilateral extra-anatomical axillary artery bypass and frozen elephant trunk technique for Kommerell’s diverticulum

2019 ◽  
Vol 2019 (7) ◽  
Author(s):  
Daisuke Takeyoshi ◽  
Hiroto Kitahara ◽  
Takamitsu Tatsukawa ◽  
Daita Kobayashi ◽  
Hayato Ise ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Axillary Artery ◽  
Artery Bypass ◽  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Anomaly ◽  
Kommerell’S Diverticulum ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract A Kommerell’s diverticulum is a rare congenital aortic arch anomaly associated with a high rate of aortic rupture or dissection. Therefore, surgical or endovascular repair should be considered early. A 64-year-old man was incidentally found to have an aortic arch anomaly, Kommerell’s diverticulum, with a right aberrant subclavian artery and distal arch aneurysm. Hybrid total arch replacement with bilateral extra-anatomical axillary artery bypass and frozen elephant trunk technique was performed. This particular surgical approach would be a treatment option for any type of Kommerell’s diverticulum.

scholarly journals The surgical management of retrograde type A aortic dissection after thoracic endovascular aortic repair

2020 ◽  
Vol 30 (5) ◽  
pp. 732-738 ◽  
Author(s):  
Yaojun Dun ◽  
Yi Shi ◽  
Hongwei Guo ◽  
Yanxiang Liu ◽  
Bowen Zhang ◽  
...  
Keyword(s):  
Total Arch Replacement ◽  
Long Term Results ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
The Mean ◽  
Frozen Elephant Trunk Technique

Abstract OBJECTIVES Our goal was to review the surgical treatment of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) in our centre. METHODS From January 2014 to April 2018, 22 patients with RTAD after TEVAR were operated on in our centre. The mean age at operation was 52.0 ± 8.0 years old. The median interval between the primary TEVAR procedure and RTAD was 4.6 months (range 0–120 months). The postoperative mortality and morbidity rates were calculated to evaluate the early and long-term results. RESULTS Twenty patients received total arch replacement with the frozen elephant trunk technique and 2 patients received total arch replacement alone. The mean cardiopulmonary bypass time, aortic cross-clamp time and selective cerebral perfusion time were 172.4 ± 39.3, 100.1 ± 30.3 and 19.7 ± 10.5 min, respectively. The incidence of major adverse events was 18.6% (4/22), including stroke in 1 patient, myocardial dysfunction in 1 patient and renal failure necessitating dialysis in 3 patients. Death within 30 days was 13.6% (3/22 patients). The follow-up data were available for all 19 survivors. The mean follow-up period was 32.2 ± 16.2 months (range 10–62 months). No deaths or aortic-related events occurred during the follow-up period. CONCLUSIONS Total arch replacement with or without the frozen elephant trunk technique was suitable for the management of RTAD after TEVAR, with acceptable early and long-term results.

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