TEVAR Following FET: Current Outcomes of Rendezvous Procedures in Clinical Practice

2021 ◽  
Author(s):  
Katrin Meisenbacher ◽  
Anja Osswald ◽  
Moritz Sebastian Bischoff ◽  
Dittmar Böckler ◽  
Matthias Karck ◽  
...  
Keyword(s):  
Aortic Surgery ◽  
Neurological Complications ◽  
Aortic Disease ◽  
Hospital Death ◽  
Elephant Trunk ◽  
Technical Success Rate ◽  
Second Stage ◽  
Morphological Findings ◽  
Cord Injury ◽  
Feasible Option

Abstract Background The treatment of extensive thoracic/thoracoabdominal aortic pathologies with arch involvement remains a challenging task in aortic surgery. The introduction of the frozen elephant trunk (FET) technique offered a link between open surgery and thoracic endovascular aortic repair (TEVAR). Despite a decade of experience, data on the complementary use of these techniques are scant. The aim of this study was to evaluate TEVAR following FET in clinical reality. Methods Between November 2006 and June 2018, 20 patients (9 females; median age of 69 years) underwent endovascular second-stage completion after FET. The clinical outcomes, technical feasibility, and morphological findings were analyzed retrospectively. Results Eleven of the 20 interventions were intended “rendezvous procedures” in a multistage approach; 4 were elective reinterventions, and 5 were emergency complication repairs. The median interval between FET and TEVAR was 231 days (11 days–7.4 years). The technical success rate was 100%. During a median follow-up (FU) period of 58.3 months, the overall survival rate was 95%, with one in-hospital death. Neurological complications occurred in three cases (spinal cord injury: n = 1; stroke: n = 2). Computed tomography angiography showed overall regression in the median diameter of the proximal descending aorta (from 57 to 48.5 mm). Conclusion TEVAR as a second-stage intervention after FET is a feasible option, with satisfactory results at medium-term FU. In extensive thoracoabdominal aortic disease without proximal landing zones, the complementary use of both techniques in a multistage approach should be considered.

Graft endoclamping with brachio-femoral wire conduit for elephant trunk retrieval in open thoraco-abdominal aortic repair

2020 ◽  
Author(s):  
Emanuele Gatta ◽  
Paolo Berretta ◽  
Luciano Carbonari ◽  
Marco Di Eusanio
Keyword(s):  
Abdominal Aorta ◽  
Aortic Disease ◽  
Proximal Anastomosis ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Descending Aorta ◽  
Aorta Aneurysm ◽  
Second Stage ◽  
Aortic Repair ◽  
Abdominal Aortic

Abstract Staged repair involving aortic arch replacement with elephant trunk (ET) technique and thoraco-abdominal aorta (TAA) replacement is the treatment of choice for patients with extensive aortic disease. The ET graft serves as a proximal platform for subsequent distal aortic repair as it allows one to avoid hazardous dissection of the distal arch and facilitate proximal anastomosis. However, in patients with large proximal descending aorta aneurysm, identifying and retrieving the ET during the second-stage TAA intervention can be challenging because of an unclampable aorta. Here, we present our brachio-femoral wire conduit technique for a safe ET clamping and retrieval during second-stage TAA procedures.

scholarly journals An Alternative Approach Using Long Elephant Trunk for Extensive Aortic Aneurysm: Elephant Trunk Anastomosis at the Base of the Innominate Artery

Circulation ◽  
2002 ◽  
Vol 106 (12_suppl_1) ◽  
Author(s):  
Satoru Kuki ◽  
Kazuhiro Taniguchi ◽  
Takafumi Masai ◽  
Takenori Yokota ◽  
Kiyoshi Yoshida ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Innominate Artery ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Hospital Death ◽  
Elephant Trunk ◽  
Mortality And Morbidity ◽  
Second Stage ◽  
Proximal Site ◽  
Elephant Trunk Procedure

Background Although a staged elephant trunk procedure has been widely used, the early mortality of the first stage operation as well as the interval mortality between operations remains unsatisfactory. We developed an alternative elephant trunk procedure to reduce mortality and morbidity. Methods and Results Ascending aorta and arch vessels were minimally dissected. During systemic cooling, a four-branched arch graft with a sewing “collar” and a long “elephant trunk” was prepared. The ascending aorta was opened under selective brain perfusion with moderate hypothermia (25°C), and the elephant trunk was then pulled down into the descending aorta using the catching catheter introduced via a femoral artery. The elephant trunk anastomosis using the collar was made at the base of the innominate artery. The arch vessels were divided and closed at aortic stump, and grafted separately as a consequence of the very proximal site for the elephant trunk anastomosis. Between October 1998 and September 2001, 17 patients, ranging in age from 25 to 79 years (mean 67 years) with extensive aortic aneurysm underwent this operation. Preoperative cardiac complications included coronary artery disease in 5, aortic regurgitation in 3, and 3 of these 8 patients had poor left ventricular function with an ejection fraction less than 40%. Nine patients underwent a second stage operation, in 1 of them the permanent elephant trunk procedure was initially attempted but the second stage procedure was done because of increasing endo-leakage. The mean interval between operations was 8 days (range 1 to 14 days) in the remaining 8 patients. In 5 of 6 patients who underwent the permanent elephant trunk procedure, a decrease in the size of the aneurysm based on thromboexclusion was observed using serial computed tomography scans. A single stage repair was performed in 1 patient. The 30-day survival rate of all operations was 100%, however, there was 1 in-hospital death (6%) after the second operation. There was no stroke, however, paraplegia occurred after the first operation in 1 patient (6%) of the in-hospital death. No new phrenic or recurrent laryngeal nerve palsy occurred as a result of surgery. Conclusions The present technique using a modification of the elephant trunk technique for extensive aortic aneurysm provides acceptable mortality and morbidity. The present strategy would be an alternative for the standard elephant trunk procedure in some high-risk patients with advanced age and comorbidities.

Use of the “elephant trunk technique” in aortic surgery

1995 ◽  
Vol 60 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Markus K. Heinemann ◽  
Beate Buehner ◽  
Michael J. Jurmann ◽  
Hans-Georg Borst
Keyword(s):  
Aortic Surgery ◽  
Elephant Trunk ◽  
Elephant Trunk Technique

“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.

Surgical outcomes of total arch replacement with modified elephant trunk technique in type A aortic dissection: insights from single-center experience

2022 ◽  
pp. 021849232110701
Author(s):  
Jian Li ◽  
Yueyun Zhou ◽  
Wei Qin ◽  
Cunhua Su ◽  
Fuhua Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement ◽  
Hospital Death ◽  
Acute Type ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Visceral Malperfusion ◽  
Cerebral Malperfusion

Background Total arch replacement with modified elephant trunk technique plays an important role in treating acute type A aortic dissection in China. We aim to summarize the therapeutic effects of this procedure in our center over a 17-year period. Methods Consecutive patients treated at our hospital due to type A aortic dissection from January 2004 to January 2021 were studied. Relevant data of these patients undergoing total arch replacement with modified elephant trunk technique were collected and analyzed. Results A total of 589 patients were included with a mean age of 53.1 ± 12.2 years. The mean of cardiopulmonary bypass, cross-clamping, and selected cerebral perfusion time were 199.6 ± 41.9, 119.0 ± 27.2, and 25.1 ± 5.0 min, respectively. In-hospital death occurred in 46 patients. Multivariate analysis identified four significant risk factors for in-hospital mortality: preexisting renal hypoperfusion (OR 5.43; 95% CI 1.31 – 22.44; P = 0.020), cerebral malperfusion (OR 11.87; 95% CI 4.13 – 34.12; P < 0.001), visceral malperfusion (OR 4.27; 95% CI 1.01 – 18.14; P = 0.049), and cross-clamp time ≥ 130 min (OR 3.26; 95% CI 1.72 – 6.19; P < 0.001). The 5, 10, and 15 years survival rates were 86.4%, 82.6%, and 70.2%, respectively. Conclusions Total arch replacement with modified elephant trunk technique is an effective treatment for acute type A aortic dissection with satisfactory perioperative results. Patients with preexisting renal hypoperfusion, cerebral malperfusion, visceral malperfusion, and long cross-clamp time are at a higher risk of in-hospital death.

scholarly journals STABILISE Technique via a Transapical Approach to Repair Residual Type A Aortic Dissection

Aorta ◽  
2021 ◽  
Author(s):  
Olivier Fouquet ◽  
Simon Dang Van ◽  
Myriam Ammi ◽  
Mickael Daligault ◽  
Christophe Baufreton ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Surgery ◽  
Type A ◽  
Thoracic Aortic Surgery ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Transcatheter Aortic Valve ◽  
Elephant Trunk Procedure ◽  
Valve Implantation ◽  
Transapical Approach

AbstractThe stent-assisted balloon-induced intimal disruption and relamination in aortic dissection or STABILISE concept is a novel endovascular strategy in Type A and Type B dissections. We report a case of Type A aortic dissection repair combining, first, an open thoracic aortic surgery with an elephant trunk procedure and, second, an endovascular treatment using the STABILISE technique via a combined transapical approach commonly used for transcatheter aortic valve implantation and a femoral pathway.

scholarly journals Minimally Invasive Aortic Arch Repair: Technical Considerations and Mid-Term Outcomes

2020 ◽  
Vol 23 (6) ◽  
pp. E803-E808
Author(s):  
Petar Risteski ◽  
Medhat Radwan ◽  
Gjoko Boshkoski ◽  
Razan Salem ◽  
Annarita Iavazzo ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Median Sternotomy ◽  
Minimal Invasive ◽  
Minimal Access ◽  
Organ Protection ◽  
Elephant Trunk ◽  
Aortic Arch Surgery ◽  
Cord Injury ◽  
Systemic Hypothermia ◽  
Aortic Arch Repair

Background: Reports of minimal invasive aortic arch surgery are scarce. We reviewed our experience with minimal access aortic arch surgery performed through an upper mini-sternotomy, with emphasis on details of operative technique and early and mid-term outcomes. Methods: The medical records of 123 adult patients (mean age 66 ± 12 years), who underwent primary elective minimal access aortic arch surgery in two aortic referral centers, were reviewed. The most common indication was degenerative aortic arch aneurysm in 92 (75%) patients. Standard operative and organ protection techniques used in all patients were upper mini-sternotomy, uninterrupted antegrade cerebral perfusion, and moderate systemic hypothermia (27.4 ± 1°C). Results: Sixty-eight (55%) patients received partial aortic arch replacement; the remaining 55 (45%) patients received total arch replacement, further extended with either a frozen elephant trunk in 43 (35%) patients or a conventional elephant trunk procedure in nine (7%) patients. No conversion to full sternotomy was required. New permanent renal failure occurred in one (0.8%) patient, stroke in two (1.6%), and spinal cord injury in four (3.3%) patients. Early mortality was observed in four (3.3%) patients. At five years, survival was 80 ± 6% and freedom from reoperation was 96 ± 3%. Conclusion: Minimal invasive aortic arch repair through an upper mini-sternotomy can be safely performed, with early and mid-term outcomes well comparable to series performed through a standard median sternotomy.

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