elephant trunk technique
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2022 ◽  
pp. 021849232110701
Author(s):  
Jian Li ◽  
Yueyun Zhou ◽  
Wei Qin ◽  
Cunhua Su ◽  
Fuhua Huang ◽  
...  

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.


Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 49
Author(s):  
Michele Murzi ◽  
Pier Andrea Farneti ◽  
Antonio Rizza ◽  
Silvia Di Sibio ◽  
Cataldo Palmieri ◽  
...  

The management of patients with aortic disease that involves the ascending aorta, the aortic arch, and the descending aorta represent a surgical challenge. Open surgical repair remains the gold standard for aortic arch pathologies. However, this operation requires a cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest, which carries a substantial rate of mortality and morbidity. For these reasons, hybrid arch repair that involves a combination of open surgery with endovascular aortic stent graft placement has been introduced as a therapeutic alternative for those patients deemed unfit for open surgical procedures. Hybrid repair requires varying degrees of invasiveness and can be performed as a single-stage procedure or as a two-stage procedure. The choice of the technique is multifactorial, depending on the characteristics of the diseased arch with regard to position of the stent graft proximal landing zone, patient fitness and comorbid status, as well as surgical expertise and hospital facilities. Among the evolving hybrid procedures is the so-called “frozen” or stented elephant trunk technique. Adapted from the classical elephant trunk technique, this approach facilitates the repair of a concomitant aortic arch and proximal descending aortic aneurysms in a single stage under circulatory arrest. This technique is increasingly being used to treat extensive thoracic aortic disease and has shown promising results.


Author(s):  
Dmitri S. Panfilov ◽  
Boris N. Kozlov

AbstractWe describe a case report of a 63-year-old man who presented with chronic left-hand weakness and the absence of a pulse in the left arm. Thoracoabdominal computed tomography (CT) revealed an extensive thoracic aortic mural thrombus. Initial anticoagulation therapy did not provide a positive result, so the patient was referred for surgery. Hybrid aortic arch surgery using the frozen elephant trunk technique was performed with excellent early outcomes. A CT performed in the early postoperative period showed that the thrombus was completely excluded from the aortic lumen by the hybrid graft. No thrombus dislodgment was detected. No thrombus recurrence was observed during 19 months of follow-up.


Aorta ◽  
2021 ◽  
Vol 09 (06) ◽  
pp. 201-214
Author(s):  
Eduardo Bossone ◽  
Riccardo Gorla ◽  
Brigida Ranieri ◽  
Valentina Russo ◽  
Heinz Jakob ◽  
...  

AbstractOver the years, the cardiovascular department of Johannes Gutenberg University in Mainz-West-German Heart Centre in Essen (Germany) designed and implemented the hybrid operating room (2003) along with advanced endovascular and surgical procedures, including the frozen elephant trunk technique. For the study purpose, the Mainz–Essen experience on acute aortic syndromes was summarized by considering original articles from single-center or multicenter studies performed at West German Heart Centre, Essen, Germany, or at the cardiovascular department of Johannes Gutenberg University, Mainz, Germany. We present the 35-year-long Mainz–Essen research, education, and patient management journey in creating an integrated multidisciplinary “Aortic Center” in the heart of Europe.


Author(s):  
Joseph S. Coselli ◽  
William C. Frankel ◽  
Susan Y. Green ◽  
Hiruni S. Amarasekara ◽  
Qianzi Zhang ◽  
...  

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zeng-Rong Luo ◽  
Mi-Rong Tang ◽  
Jia-Hui Li ◽  
Liang-Wan Chen ◽  
Liang-Liang Yan

Abstract Objective To compare the effects of modified triple-branched stent implantation and frozen elephant trunk technique on the quality of life (QoL) of acute Stanford Type A aortic dissection (AAAD) patients at different follow-up times. Methods Data from 175 AAAD survivors was collected which were divided into two groups according to different surgical techniques: (group A): modified triple-branched stent graft implantation; (group B): frozen elephant trunk. The SF-36 were used to assess the QoL at discharge (AD), the third postoperative month (POM3), and the twelfth postoperative month (POM12). Results (1) The total scores at each time of both groups showed lower than the normal level; Group A scored higher than group B at some time points in terms of some items (role physical, role emotion and mental health; all P = 0.000), and some items at POM3 or POM12 scored higher than at discharge (role physical, social function; both P = 0.000). (2) There were less patients with heavy self-perceived burden in group A than group B at discharge (P = 0.032) and patients with heavy self-perceived burden decreased over time. (3) Young postoperative AAD patients (P = 0.002) in group B (P = 0.005) with heavy self-perceived burden (P = 0.000), acute renal failure (P = 0.008), long LOS (P = 0.026) and blood loss (> 1000 mL/24 h) (P = 0.039) seemed to get a worse QoL. Conclusion The impact on QoL of the modified triple-branched stent graft implantation technique seemed to be better than those of frozen elephant trunk surgery in role physical, role emotion and mental health.


2021 ◽  
Author(s):  
Zeng-Rong Luo ◽  
Mi-Rong Tang ◽  
Jia-Hui Li ◽  
Liang-Wan Chen ◽  
Liang-Liang Yan

Abstract Objective: To compare the effects of modified triple-branched stent implantation and frozen elephant trunk technique on the quality of life (QoL) of acute Stanford Type A aortic dissection (AAAD) patients at different follow-up times.Methods: Data from 175 AAAD survivors was collected which were divided into two groups according to different surgical techniques: (group A): modified triple-branched stent graft implantation; (group B): frozen elephant trunk. The SF-36 were used to assess the QoL at discharge(AD), the third postoperative month (POM3), and the twelfth postoperative month (POM12).Results: (1)The total scores at each time of both groups showed lower than the normal level; Group A scored higher than group B at some time points in terms of some items (role physical, role emotion and mental health; all P=0.000), and some items at POM3 or POM12 scored higher than at discharge (role physical, social function; both P=0.000). (2) There were less patients with heavy self-perceived burden in group A than group B at discharge (P=0.032) and patients with heavy self-perceived burden decreased over time. (3) Young postoperative AAD patients (P=0.002) in group B (P=0.005) with heavy self-perceived burden (P=0.000) , acute renal failure (P=0.008) , long LOS (P=0.026) and blood loss(> 1000 mL / 24h)(P=0.039) seemed to get a worse QoL. Conclusion: The impact on QoL of the modified triple-branched stent graft implantation technique seemed to be better than those of frozen elephant trunk surgery in role physical, role emotion and mental health.


Author(s):  
Jacky Y K Ho ◽  
Kevin Lim ◽  
Takuya Fujikawa ◽  
Randolph H L Wong

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.


2021 ◽  
pp. 153857442110375
Author(s):  
Shigeo Ichihashi ◽  
Satoru Nagatomi ◽  
Shinichi Iwakoshi ◽  
Tomoaki Hirose ◽  
Francesco Bolstad ◽  
...  

Background: Patent false lumens carry a high risk of aortic events including rupture. False lumen embolization is a useful method to promote thrombosis of false lumen. In the case presented here, direct penetration of the dissected membrane was employed to obtain access to the false lumen, enabling embolization. Case report: The case was a 64-year-old female who developed a Stanford type A acute aortic dissection. Replacement of ascending aorta and aortic arch with frozen elephant trunk technique was performed. After the operation, there was a residual flow through the false lumen in the descending thoracic and abdominal aorta. Twenty months later, the patient complained of sudden back pain, and a CT scan demonstrated another new dissection at the distal edge of the open stent. Additionally, the false lumen that had remained since the onset of the type A aortic dissection enlarged during the observation period. An endovascular procedure was planned to exclude the false lumen. Despite closing all communicating channels between true and false lumen using a vascular plug, coils, and stent grafts, the false lumen continued to expand due to the residual flow at the visceral segment. The origin responsible for the flow was not identified. To perform an embolization of the false lumen, access into the false lumen was obtained by penetration of the dissected flap using a trans-septal needle. Following the successful penetration of the flap, embolization of the false lumen was performed using coils and glue. After the embolization, an angiogram of the false lumen confirmed the significant reduction of leakage into the true lumen. The size of the aorta and false lumen decreased after the embolization. Conclusion: Direct penetration of the dissected membrane of the aorta was a safe and useful measure for regaining access to the false lumen and for the following endovascular intervention.


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