Frozen elephant trunk procedure for DeBakey type i acute aortic dissection complicated by lower limb malperfusion

Abstract Background Distal anastomosis bleeding is an issue during total arch replacement with the frozen elephant trunk technique. We used the 4-branched graft inversion technique for the distal anastomosis in acute aortic dissection. The aim was to evaluate the feasibility and benefits of the technique used during the frozen elephant trunk procedure for acute aortic dissection. Methods From January 2017 to July 2019, 109 patients underwent total arch replacement for type A acute aortic dissections. Patients were divided according to the technique used for the distal anastomosis as follows: group G (n = 57; 4-branched graft inversion technique) and group C (n = 52; conventional method with Teflon felt). The postoperative variables were analysed. Results The hospital mortality rate was 9.2% (10/109). The mean cardiopulmonary bypass, cardiac arrest, and circulatory arrest times were 234.95 ± 71.88 min, 168.25 ± 61.33 min, and 39.19 ± 9.45 min, respectively. The circulatory arrest and cardiac arrest times were shorter in the graft inversion group than in the conventional group (36.46 ± 7.88 min vs. 42.19 ± 10.17 min, P = 0.001 and 156.21 ± 55.99 min vs. 181.44 ± 64.68 min, P = 0.031, respectively). There were 7 cases of stroke (6.4%) and 5 cases of paraplegia (4.6%). Additionally, 13 patients (11.9%) required temporary continuous renal replacement therapy. Respiratory failure occurred in 19 patients (17.4%). There were no significant differences in postoperative complications between the two groups. Conclusions The 4-branched graft inversion technique provides effective and confirmed haemostasis during total aortic arch replacement using the frozen elephant trunk procedure.

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Total aortic arch replacements with a 4 branched Frozen Elephant Trunk (FET) Graft in Acute aortic dissection (DeBakey type I).

Operative Techniques in Thoracic and Cardiovascular Surgery ◽

10.1053/j.optechstcvs.2021.12.004 ◽

2022 ◽

Author(s):

Malakh Shrestha ◽

Erik Beckmann ◽

Tim Kaufeld ◽

Axel Haverich ◽

Andreas Martens

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Acute Aortic Dissection ◽

Type I ◽

Frozen Elephant Trunk ◽

Elephant Trunk

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Impact of Modified Frozen Elephant Trunk Procedure on Downstream Aorta Remodeling in Acute Aortic Dissection: CT Scan Follow-Up

World Journal of Surgery ◽

10.1007/s00268-020-05374-9 ◽

2020 ◽

Vol 44 (5) ◽

pp. 1648-1657

Author(s):

Luca Koechlin ◽

Josefin Kaufmann ◽

Evelina Macius ◽

Jens Bremerich ◽

Gregor Sommer ◽

...

Keyword(s):

Aortic Dissection ◽

Ct Scan ◽

Acute Aortic Dissection ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Elephant Trunk Procedure

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Frozen elephant trunk usage in acute aortic dissection

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320951304 ◽

2020 ◽

pp. 021849232095130

Author(s):

Yutaka Okita

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Clinical Applications ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Elephant Trunk Procedure

This review discusses the clinical applications of the frozen elephant trunk procedure for patients with acute aortic dissection. Sub-analysis of the multicenter Japanese Frozenix study, J-ORCHESTRA, are presented, and recent reports of frozen elephant trunk usage for acute aortic dissection are discussed.

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Combined David and Frozen Elephant Trunk Procedure in Acute Aortic Dissection

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1667179 ◽

2018 ◽

Vol 67 (05) ◽

pp. 372-378 ◽

Cited By ~ 1

Author(s):

Nora Goebel ◽

Ragi Nagib ◽

Schahriar Salehi-Gilani ◽

Samir Ahad ◽

Marc Albert ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Acute Aortic Dissection ◽

Aortic Root Replacement ◽

Type I ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Valve Sparing ◽

Aortic Root Repair ◽

Aortic Remodeling

Background Valve sparing aortic root repair by reimplantation (David procedure) is an established technique in acute aortic dissection Stanford type A involving the aortic root. In DeBakey type I dissection, aortic arch replacement using the frozen elephant trunk (FET) was introduced to promote aortic remodeling of the downstream aorta. The combination of these two complex procedures represents a challenging surgical strategy and was considered too risky so far. Methods All patients with acute aortic dissection DeBakey type I undergoing valve sparing aortic root repair by reimplantation technique of David combined with extended aortic repair using the FET at our center between October 2009 and December 2016 were evaluated. Outcomes are compared with patients who underwent prosthetic aortic root replacement and FET for aortic dissection in the same timeframe. Results A total of 28 patients received combined David and FET procedure, while 20 patients received prosthetic aortic root replacement and FET procedure. Thirty-day mortality was 10.7% (n = 3) for the David group and 20% (n = 4) for the root replacement group (p = 0.43). Postoperative echocardiographic control revealed an excellent aortic valve function with regurgitation grade 0° or maximum grade I° and a mean gradient of 4.3 ± 2.1 mm Hg in all patients in the David group versus 7.2 ± 2.4 mm Hg in the aortic root replacement group, p = 0.003. Computed tomography angiography scan showed positive aortic remodeling in all but three patients (91.9%). Mid-term follow-up survival was 82.1% in the David group and 68.4% in the root replacement group, p = 0.28. There was no need for reintervention at the root or descending aorta. Conclusion Simultaneous application of the David and FET procedure in patients with acute aortic dissection is safe and feasible in experienced hands as compared with standard aortic root replacement plus FET. The mid-term outcomes are encouraging and noninferior to conventional surgery results.

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Faculty Opinions recommendation of Total aortic arch replacement with the frozen elephant trunk procedure in acute DeBakey type I aortic dissections.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727227099.793527919 ◽

2017 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Arch ◽

Type I ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Total Aortic Arch Replacement ◽

Elephant Trunk Procedure ◽

Aortic Dissections

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The zone 2 concept and distal stent graft positioning in TH 2–3 are associated with high rates of secondary aortic interventions in frozen elephant trunk surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab132 ◽

2021 ◽

Author(s):

Markus Liebrich ◽

Efstratios I Charitos ◽

Sebastian Schlereth ◽

Helfried Meißner ◽

Tobias Trabold ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Type A ◽

Distal Anastomosis ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Hybrid Prosthesis ◽

Elephant Trunk Procedure ◽

Graft Length ◽

Aortic Dissection Type A

Abstract OBJECTIVES The goal of this study was to investigate the association between the localization of the distal anastomosis (zone 2/3), the stent graft length (100–160 mm), the position of the distal end of the hybrid prosthesis and the need for secondary aortic intervention (SAI) in acute and chronic thoracic aortic disease after the frozen elephant trunk procedure. METHODS From 2009 through 2020, a total of 232 patients (137 men; mean age, 61.7 ± 13.8 years) were treated with the frozen elephant trunk procedure. The main indications were acute aortic dissection type A (n = 106, 46%), chronic aortic dissection type A (n = 52, 22%) and degenerative thoracic aortic aneurysm (n = 74, 32%). RESULTS The rate of SAI was significantly higher when we performed a distal anastomosis in zone 2 rather than in zone 3, whereas the rate of SAI was less frequent if the distal positioning of the hybrid prosthesis was below TH 4–5. Combining the zone 2 concept and the short stent graft length (100 mm) was associated with a significantly higher rate of SAIs. Patients with a distal anastomosis in zone 2 were significantly less likely to have a recurrent laryngeal nerve injury (P < 0.001). However, no association between a specific arch zone of a distal anastomosis and the occurrence of spinal cord injury was observed. CONCLUSIONS Rates of SAIs are highest in patients who were treated with a distal anastomosis in zone 2 and a short stent graft (100 mm) with the distal end of the hybrid prosthesis at vertebral level TH 2–3.

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