Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies.

Carlo Mariani,Giacomo Murana,Davide Pacini,Alessandro Leone,Luca Di Marco

doi:10.3390/medicina57101090

Carlo Mariani, Giacomo Murana + Show 3 more

Open Access

https://doi.org/10.3390/medicina57101090

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Abstract

The frozen elephant trunk technique (FET) requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft component, which is placed into the proximal descending thoracic aorta (DTA) anterogradely in the proximal descending thoracic aorta. In Europe, two hybrid prostheses are available: the E-evita Open Plus hybrid stent graft system provided by JOTEC (Hechingen, Germany) and the ThoraflexTM Hybrid (Vascutek, Inchinnan Scotland). Recommendations for use are extensive pathologies of the arch in case of acute and chronic aortic dissection, degenerative aneurysm and intramural hematoma. The FET approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally. The remarkable feature of this technique is the possibility to perform more proximally (from zone 3 to zone 0) the distal anastomosis in to the arch. This allows for an easier distal anastomosis, reduced hypothermic circulatory arrest time and decreased risk of paraplegia (<5%). Early results are promising and according to the most recent series the rate of developing post-operative renal insufficiency ranges from 3 to 10%, the risk of stroke from 3% to 8% and mortality from 8–15%. The aim of the article will be to provide some knowledge about the use and application of FET procedures in different aortic situations.

Highlights

Complex aortic disease involving the thoraco-abdominal aorta is one of the hardest for cardiac surgeons to handle
The elephant trunk technique requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft (SG) component, which is placed into the proximal descending thoracic aorta anterogradely
The frozen elephant trunk (FET) approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally

Summary

Introduction

Complex aortic disease involving the thoraco-abdominal aorta is one of the hardest for cardiac surgeons to handle. The ideal treatment should carry an operative risk within acceptable boundaries and play a key role for subsequent procedures as required. For this reason, the conventional elephant trunk (CET) and even more the frozen elephant trunk (FET) fulfil these requirements for the treatment of complex aortic disease. The elephant trunk technique requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft (SG) component, which is placed into the proximal descending thoracic aorta anterogradely. The FET approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally

Devices

Chronic Aortic Dissection

Intramural Hematoma

Surgical Technique—How We Do It in Bologna

Findings

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