scholarly journals Early and long-term results of total arch replacement with the frozen elephant trunk technique for acute type A aortic dissection

2020 ◽  
Vol 58 (4) ◽  
pp. 707-713 ◽  
Author(s):  
Akihiro Yoshitake ◽  
Masato Tochii ◽  
Chiho Tokunaga ◽  
Jun Hayashi ◽  
Akitoshi Takazawa ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Term Survival ◽  
Type A Aortic Dissection ◽  
Long Term Survival

Abstract OBJECTIVES We evaluated the operative and long-term outcomes of the frozen elephant trunk (FET) technique for acute type A aortic dissection. METHODS This study evaluated 426 consecutive patients who underwent aortic repair for acute type A aortic dissection from June 2007 to December 2018 at our centre. Of these, 139 patients underwent total arch replacement with FET (FET group), and 287 underwent other procedures (no FET group). Ninety-two patients in the FET group were matched to 92 patients in the no FET group by using propensity score matching analysis. RESULTS Thirty-day mortality and neurological dysfunction were not significantly different between the FET and no FET groups (1.4% vs 2.4%, P = 0.50 and 5.0% vs 6.3%, P = 0.61, respectively). Long-term survival was better in the FET group than in the no FET group (P = 0.008). Freedom from distal thoracic reintervention was similar in the FET and no FET groups (P = 0.74). In the propensity-matched patients, freedom from aortic-related death was better in the FET group than in the no FET group (P = 0.044). CONCLUSIONS Operative outcomes showed no significant difference between the 2 groups. FET contributes to better long-term survival in patients with acute type A aortic dissection.

Aortic root surgery improves long-term survival after acute type A aortic dissection

2015 ◽  
Vol 184 ◽  
pp. 285-290 ◽  
Author(s):  
Ilir Hysi ◽  
Francis Juthier ◽  
Olivier Fabre ◽  
Olivier Fouquet ◽  
Natacha Rousse ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Acute Type ◽  
Term Survival ◽  
Type A Aortic Dissection ◽  
Long Term Survival ◽  
Aortic Root Surgery

Alternatives to the frozen elephant trunk in acute type A aortic dissection

2020 ◽  
pp. 021849232092874
Author(s):  
Bashi V Velayudhan ◽  
A Mohammed Idhrees
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Long Term Results ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Multiple Strategies ◽  
The Cost

Acute type A aortic dissection remains one of the most challenging condition in cardiothoracic surgery, with a high mortality rate. Various improvements and innovations have happened over the years to better the outcome of this lethal condition. The frozen elephant trunk prosthesis has been developed to negate the long-term complications of acute type A aortic dissection, but at the cost of increased morbidity compared to hemiarch replacement. Although hemiarch and total arch replacement seem have less morbidity than the frozen elephant trunk technique, they do not address the long-term complications of the distal dissected aorta. Few surgeons now suggest hybrid aortic arch repair as a solution for acute type A aortic dissection. The long-term results need to be studied in all procedures before standardizing them. Although multiple strategies are evolving, the short-term goal of acute type A aortic dissection has not changed: to save the patient’s life. The surgical strategy has to be tailored according to the patient’s condition and the surgeon’s experience.

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.

Predictors for long-term survival in patients with acute type A aortic dissection

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
J Brickwedel ◽  
M Coutandin ◽  
HO Pinnschmidt ◽  
AM Bernhardt ◽  
H Reichenspurner ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Term Survival ◽  
Type A Aortic Dissection ◽  
Long Term Survival
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