scholarly journals Commentary: Spinal cord injury after the frozen elephant trunk procedure: Are we really safe now?

2020 ◽  
Vol 159 (4) ◽  
pp. 1199-1200
Author(s):  
Oliver J. Liakopoulos
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Cord Injury ◽  
Elephant Trunk Procedure

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

2018 ◽  
Vol 26 (6) ◽  
pp. 972-976 ◽  
Author(s):  
Boris N Kozlov ◽  
Dmitri S Panfilov ◽  
Igor V Ponomarenko ◽  
Andrey G Miroshnichenko ◽  
Aleksandra A Nenakhova ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Cord Injury ◽  
Elephant Trunk Procedure

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

2021 ◽  
pp. 153857442110024
Author(s):  
Rozina Yasmin Choudhury ◽  
Kamran Basharat ◽  
Syeda Anum Zahra ◽  
Tien Tran ◽  
Lara Rimmer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Literature Review ◽  
Treatment Options ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Cord Injury ◽  
Aortic Pathologies

Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

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

2020 ◽  
Vol 68 (10) ◽  
pp. 1119-1127
Author(s):  
Yu Hohri ◽  
Takuma Yamasaki ◽  
Yuichi Matsuzaki ◽  
Takeshi Hiramatsu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Cord Injury ◽  
Spinal Cord Protection

Abstract 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.

scholarly journals Extensive deployment of the stented elephant trunk is associated with an increased risk of spinal cord injury

2006 ◽  
Vol 131 (2) ◽  
pp. 336-342 ◽  
Author(s):  
Jorge Flores ◽  
Takashi Kunihara ◽  
Norihiko Shiiya ◽  
Kimihiro Yoshimoto ◽  
Kenji Matsuzaki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Elephant Trunk ◽  
Increased Risk ◽  
Cord Injury

scholarly journals Single-Stage Treatment of Extensive Aortic Pathology Using the Frozen Elephant Trunk Procedure

2020 ◽  
Vol 23 (5) ◽  
pp. E606-E610
Author(s):  
Petar Risteski ◽  
Vasil Papestiev ◽  
Stefanija Hadzievska ◽  
Nadica Mehmedovic ◽  
Nikola Lazovski ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Single Stage ◽  
Frozen Elephant Trunk ◽  
Organ Protection ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Cardiac Morbidity ◽  
Aortic Pathology ◽  
Cord Injury ◽  
Elephant Trunk Procedure

Background: Extensive pathology involving the aortic arch and descending aorta traditionally has been treated with two open procedures. We report our institutional experience with a single stage frozen elephant trunk procedure for treatment of extensive aortic pathology. Methods: Between June 2018 and October 2019, nine patients (eight males, 89%, mean age 61 ± 6 years) with extensive aortic pathology were operated using the frozen elephant trunk procedure. Five (56%) patients underwent primary operation for chronic arch and proximal descending aneurysm in two (22%) patients, chronic type B aortic dissection in two (22%) patients and penetrating aortic ulcer in one (11%) patient. The other four (44%) patients received reoperative surgery for chronic post-dissection aneurysms. For organ protection during the aortic arch procedure, we used selective antegrade cerebral perfusion and mild systemic hypothermia at 28°C. Results: Early mortality was not observed. A single (11%) patient developed focal stroke. Unilateral vocal cord palsy was present in two (22%) patients. Spinal cord injury was not observed. Reexploration for bleeding was required in two (22%) patients. Prolonged ventilation, liver and kidney failure as well as cardiac morbidity were not observed. Two patients (22%) with anticipated Endoleak type Ib received TEVAR extension at follow up. Mid-term mortality was observed in two (22%) patients, due to pneumonia. Conclusion: The frozen elephant trunk procedure can be used for a single-stage treatment of patients with extensive aortic pathology, due to chronic degenerative aneurysms or post-dissection aneurysms involving the aortic arch and the descending aorta, with acceptable mortality and morbidity.

scholarly journals Comparative study of the frozen elephant trunk and classical elephant trunk techniques to supplement total arch replacement for acute type A aortic dissection†

2019 ◽  
Vol 56 (3) ◽  
pp. 579-586 ◽  
Author(s):  
Yosuke Inoue ◽  
Hitoshi Matsuda ◽  
Atsushi Omura ◽  
Yoshimasa Seike ◽  
Kyokun Uehara ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Aortic Dissection ◽  
Pulmonary Vein ◽  
Type A ◽  
Total Arch Replacement ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Cord Injury

Abstract OBJECTIVES In patients with acute type A aortic dissection, the use of the frozen elephant trunk (FET) procedure with total arch replacement (TAR) has been indicated for emergency operations to obtain thrombosis of the distal false lumen (FL). However, data comparing the FET and the classical elephant trunk (CET) procedures, including the incidences of mortality, morbidity, spinal cord injury and aortic remodelling, have not yet been reported. The goal of this study was to compare the early outcomes of TAR with the FET and the CET procedures. METHODS The past 7 years of medical records of 323 patients with type A aortic dissection who underwent emergency surgery were reviewed retrospectively, and 148 patients who underwent TAR were shortlisted for the study. First, the patients were divided into 2 groups, the CET group (n = 115; age 65 ± 12 years) and FET group (n = 33; 67 ± 11 years), to compare the early operative outcomes, including mortality and morbidity. Second, 86 patients (CET 56; FET 30) fulfilling the inclusive criteria (inserted length of elephant trunk ≥5 cm, involvement of dissection at the descending aorta and sufficient computed tomographic evaluation at ≥6 months after the operation) were compared to evaluate the patency and diameter of the FL at each segment of the downstream aorta. RESULTS The in-hospital mortality rate was 8.1% (12/148), without significant differences between the 2 groups (CET 8.7% vs FET 6.1%; P = 1). No spinal cord ischaemia was encountered in either group. The incidence of postoperative FL patency at the level of the left lower pulmonary vein was 30% in the FET group, which was significantly lower than that in the preoperative state (73%) and in the CET group (77%). The downsizing of the aortic diameter at the distal edge of the CET or the FET, the left lower pulmonary vein and the coeliac axis was significant in the FET group 6 months after TAR. CONCLUSIONS According to our initial experience, the FET compared to the CET procedure showed comparable early complications and an advantage concerning FL thrombosis and aortic remodelling at early follow-up examinations.

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