Frozen elephant trunk surgery using the Vascutek Thora-flex hybrid prosthesis.

Abstract

The Vascutek Thoraflex hybrid graft (Vascutek, Scotland) is a novel commercially available 4-branched frozen elephant trunk (FET) graft used to treat patients with extensive diseases of the thoracic aorta (1). This hybrid prosthesis is composed of a distal endograft sealed to a proximal 4-branched gelweave graft with an incorporated sewing collar (Figure 1). Figure 1 The Vascutek Thora-flex hybrid prosthesis The text of this manuscript describes our FET technique with the Vascutek Thoraflex hybrid graft in detail (Video 1). Video 1 Frozen elephant trunk surgery using the Vascutek Thora-flex hybrid prosthesis Clinical vignette A 73-year-old man who had undergone a supra-coronary ascending aorta replacement for a DeBakey type 1 acute aortic dissection in a different Institution in 1997 was recently referred to our hospital for a residual chronic post-dissection aneurysm of the thoraco-abdominal aorta. Upon admission, the angio CT scan showed severe dilatation of the thoracic (48 mm) and abdominal (72 mm) aorta. The false lumen of the abdominal aorta was completely thrombosed; all the visceral vessels originated from the true lumen of the dissection with the exception of the left renal artery; large intimal tears were identified at the origin of the innominate artery and at the level of distal descending thoracic aorta. The native aortic root measured 33 mm (Figure 2). A trans-thoracic echocardiogram showed a competent tricuspid aortic valve and a normal left ventricular ejection fraction (62%). The preoperative coronary angiogram revealed severe 3-vessel coronary artery disease with critical stenoses of the left anterior descending, obtuse marginal and right coronary arteries. Figure 2 Angio CT image showing the residual DeBakey type 1 aortic dissection of the thoraco-abdominal aorta The patient was scheduled for a 3-staged hybrid treatment involving complete arch replacement with the FET and myocardial revascularization (stage 1), replacement of the abdominal aorta with visceral vessel de-branching (stage 2), and endovascular stenting of the remaining aortic segments from the FET to the abdominal aortic graft (stage 3). This video focuses on the stage-one procedure.