Frozen Elephant Trunk Technique Research Articles

Can preoperative features predict residual false lumen remodelling after tear-oriented limited resection for acute type I dissection?

Our goal was to identify the preoperative findings in computed tomography correlated with the postoperative changes of the false lumen (FL) remaining in the descending thoracic aorta following tear-oriented surgery for acute type I dissection. Patients who underwent ascending +/- partial arch replacement, with available preoperative and postoperative late (>1 year) CT scans, were included. Preoperative cross-sectional parameters were measured by the semi-automated centreline method at the level of the anastomosis. The parameters of the patients who presented positive remodelling of the proximal descending thoracic aorta were compared with those of the patients who did not in the late images. Among the included 101 patients, positive remodelling of the proximal descending thoracic aorta was observed in 46.5%, of which 76.6% extended downwards to the middle descending thoracic aorta. In the univariable analysis, an FL area ratio <50% (P < 0.001), a circumferential ratio of dissection <50% (P = 0.028), an FL width <20 mm (P = 0.008) at the distal anastomotic zone and not leaving residual arch branches having patent false lumens (P = 0.005) correlated with positive remodelling. The number of fulfilled above-mentioned features revealed a better correlation, which was stronger in patients without Marfan syndrome and in those older than 50 years. The cross-sectional extent of dissection at the presumed distal anastomotic zone is associated with descending thoracic aorta positive remodelling following tear-oriented replacement for acute type I aortic dissection. Considering the anatomical features in determining the extent of aortic replacement, some of the non-Marfan elderly patients can be spared from aggressive total arch replacement with the frozen elephant trunk technique.

E-Vita OPEN NEO Hybrid Stent Graft: A New Frontier for Total Arch Replacement

The ever-changing landscape of aortic arch surgery necessitates a constant update on the available devices and technologies for the contemporary management of complex aortic diseases. The E-Vita OPEN NEO hybrid stent graft system offers a unique approach for aortic arch replacement with the frozen elephant trunk technique. In contrastto its predecessors and other commercially available devices, it fits to each individual patient's needs by allowing for more proximal graft anastomosis. We sought to present our initial experience with the novel E-Vita OPEN NEO hybrid stent graft system focusing on its description, optimal graft selection, operative technique, and results in a clinical setting. We prospectively collected data on all patients in whom the E-Vita OPEN NEO device was used between October 2020 and May 2021. The primary outcome was perioperative or with 30-day mortality. Secondary outcomes were the incidence of neurologic complications (stroke and spinal cord ischemia) and endoleak on a postoperative computed tomography angiography. During the study period, six patients received the novel hybrid stent device. The mean patient age was 59.3±13.3years and 83% were male. Two patients were operated on an emergent setting due to acute Stanford type A aortic dissection and there were two reoperations in patients with a history of previous repaired type A dissection. There was no perioperative or 30-day mortality and none of the patients exhibited adverse neurologic events. Two patients required completion thoracic endovascular repair due to type Ib endoleak. One patient died after a prolonged stay in the intensive care unit due to pneumonia and multiorgan failure. This novel device adapts to each patient's characteristics and offers a curative option for acute and chronic aortic arch and descending aortic conditions such as aneurysmal disease and aortic dissection. In addition, it offers an excellent landing station for potential endovascular therapies and allows for complete aortic remodeling.

Total arch replacement using frozen elephant trunk technique with Frozenix for distal aortic arch aneurysms.

OBJECTIVESTotal arch replacement (TAR) using an endovascular approach has been initially introduced as the frozen elephant trunk technique (FET). In our institute, TAR using the FET with Frozenix has been used as the first-line treatment for distal aortic arch aneurysms since 2014. This study aimed to evaluate the early and long-term outcomes and demonstrate the efficacy of this procedure.METHODSBetween 2014 and 2021, 121 consecutive patients were treated with TAR using the FET with Frozenix for distal aortic arch aneurysms. Early and long-term outcomes were retrospectively analysed.RESULTSThe 30-day mortality rate was 2.5% (3/121). Of postoperative complications, paraplegia due to spinal cord injury occurred in 2 (1.7%) patients, stroke in 12 (9.9%) and acute renal failure in 10 (8.3%). At follow-up, 23 secondary aortic interventions were required and 8 (6.6%) patients underwent intended secondary thoracic endovascular aortic repair for residual descending aortic aneurysm. Late and aortic-related deaths occurred in 16 (13.2%) and 4 (3.3%) patients, respectively. The overall long-term survival rates at 1, 3 and 5 years were 87.6%, 83.1% and 65.4%, respectively, while the rates of freedom from aortic-related death at 1, 3 and 5 years were 95.7%, 95.7% and 84.8%, respectively.CONCLUSIONSTAR using the FET with Frozenix for distal aortic arch aneurysms has acceptable early mortality and morbidity. Spinal cord injury and paraplegia occur less frequently than previously reported. The technique has satisfactory long-term survival and freedom from aortic-related death.

Total Arch Replacement With Frozen Elephant Trunk Using a NEW "Brain-Heart-First" Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (≥30°C) With Satisfactory Outcomes.

BackgroundTotal arch replacement (TAR) with Frozen elephant trunk (FET) treatment of acute DeBakey type I aortic dissection (ADIAD) is complicated, carries a high complication/mortality risk and remains controversial on the optimal hypothermic level, cerebral perfusion and visceral organ protection strategy. We developed a new strategy named “Brain-Heart-first” in which the surgical procedures and the management of cardiac perfusion/cerebral protection during Cardiopulmonary bypass (CPB) were redesigned, and TAR with FET technique can be performed under mild hypothermia with satisfactory outcomes.ObjectiveOur aims were to describe a new surgical strategy under mild hypothermia (≥30°C) for the treatment of ADIAD and to report the operative outcomes of 215 patients.MethodsWe conducted a retrospective analysis of 215 consecutive cases of ADIAD treated with our new strategy.ResultsThe durations of CPB, aortic cross-clamping, antegrade cerebral perfusion, operation, mechanical ventilation support, and Intensive Care Unit stay were 139.7 ± 52.3 min, 55.6 ± 27.4 min, 14.1 ± 3.1 min, 6.0 ± 1.7 h, 40.0 h and 4.0 d, respectively. The 30-day mortality was 9.8%, with cerebral stroke occurring in nine patients (4.2%), paraplegia in one patient (0.5%) and postoperative renal injury requiring dialysis in 21 patients (9.8%). The blood transfusion of red blood cells and fresh frozen plasma during surgery and the first 24 h after surgery was 4.0 u and 200.0 ml, respectively.ConclusionsThe Brain-Heart-first strategy can be widely used with low technical and resource requirements and provides a safe alternative for conventional TAR with FET technique in ADIAD patients with satisfactory operative results.

Non-A non-B acute aortic dissection with entry tear in the aortic arch.

OBJECTIVESOur aim was to describe the outcomes of the latest treatment options of acute non-A non-B aortic dissection involving an entry tear in the aortic arch.METHODSIncluded were patients who presented between January 2001 and February 2020 with a non-A non-B aortic dissection involving the aortic arch but not the ascending aorta and with the most proximal entry tear located within the aortic arch between the innominate and left subclavian artery. Clinical data and operative details were retrieved from medical histories and surgical protocols. Preoperative, postoperative and follow-up computed tomography angiography scans were analysed.RESULTSWe analysed a total of 39 patients [median age 62 (52; 67) years, men 76.9%] with non-A non-B arch entry aortic dissections type. They underwent 15 thoracic endovascular aortic repairs, 20 frozen elephant trunk implantations, 1 hybrid arch replacement, or 1 conventional arch replacement. Two patients were managed conservatively. Twelve (31%) patients underwent emergent intervention, 12 (31%) were treated invasively within 2 weeks. Another 2 (5%) and 9 (23%) patients were treated 2 and 4 weeks after dissection occurred, respectively. Six (15%) patients presented with an impending aortic rupture, while 19 (49%) had at least one malperfused organ. Four patients (27%) died after thoracic endovascular aortic repair; the 30-day mortality following frozen elephant trunk was 0%.CONCLUSIONSNon-A non-B acute aortic dissection reveals a frequently complicated course requiring emergency intervention. The majority of patients required aortic arch repair within the first 2 weeks. Total arch replacement with the frozen elephant trunk technique seems to be low procedural mortality, and may become the treatment of choice in arch entry non-A non-B aortic dissection.

Morphometric Predictors of Aortic Remodeling after Frozen Elephant Trunk Repair of Type A Dissection

We analyzed the predictors of postoperative aortic remodeling after the frozen elephant trunk technique for type A dissection. This retrospective study cohort comprised 20 patients who underwent the frozen elephant trunk technique for type A dissection. The incidence of aortic remodeling was evaluated at 4 levels: middle of the frozen elephant trunk, distal end of the frozen elephant trunk, 10th thoracic vertebra, and proximal to the celiac artery. Several parameters of the residual dissected aorta were analyzed at these 4 levels, and the predictors of aortic remodeling were investigated. The incidence of aortic remodeling was 85% at the middle of the frozen elephant trunk, 70% at the distal end of the frozen elephant trunk, 50% at the 10th thoracic vertebra, and 35% proximal to the celiac artery. In a total of 80 computed tomography images, there were significant differences between the aortic remodeling and nonremodeling groups in the true lumen diameter, false lumen diameter, true lumen/aortic diameter ratio, true lumen area, true lumen/aortic area ratio, and 2 parameters explaining the shape of the true lumen (created using elliptic Fourier analysis). Multivariate analysis revealed that the independent predictors of aortic remodeling were the true lumen/aortic area ratio and principal component 1. There were high incidences of aortic remodeling at the middle and distal end of the frozen elephant trunk. Multivariate analysis showed that the true lumen/aorta area ratio and the shape of the true lumen may be important predictors of aortic remodeling.

Risk factors for stroke after total aortic arch replacement using the frozen elephant trunk technique.

OBJECTIVESThis study aimed to analyse risk factors for postoperative stroke, evaluate the underlying mechanisms and report on outcomes of patients suffering a postoperative stroke after total aortic arch replacement using the frozen elephant trunk technique.METHODSTwo-hundred and fifty patients underwent total aortic arch replacement via the frozen elephant trunk technique between March 2013 and November 2020 for acute and chronic aortic pathologies. Postoperative strokes were evaluated interdisciplinarily by a cardiac surgeon, neurologist and radiologist, and subclassified to each’s cerebral territory. We conducted a logistic regression analysis to identify any predictors for postoperative stroke.RESULTSOverall in-hospital was mortality 10% (25 patients, 11 with a stroke). A symptomatic postoperative stroke occurred in 42 (16.8%) of our cohort. Eight thereof were non-disabling (3.3%), whereas 34 (13.6%) were disabling strokes. The most frequently affected region was the arteria cerebri media. Embolism was the primary underlying mechanism (n = 31; 73.8%). Mortality in patients with postoperative stroke was 26.2%. Logistic regression analysis revealed age over 75 (odds ratio = 3.25; 95% confidence interval 1.20–8.82; P = 0.021), a bovine arch (odds ratio = 4.96; 95% confidence interval 1.28–19.28; P = 0.021) and an acute preoperative neurological deficit (odds ratio = 19.82; 95% confidence interval 1.09–360.84; P = 0.044) as predictors for postoperative stroke.CONCLUSIONSStroke after total aortic arch replacement using the frozen elephant trunk technique remains problematic, and most lesions are of embolic origin. Refined organ protection strategies, and sophisticated monitoring are mandatory to reduce the incidence of postoperative stroke, particularly in older patients presenting an acute preoperative neurological deficit or bovine arch.

Aortic Valve and Arch Replacements in a High-Risk Patient with Essential Thrombocythemia

Reports of the clinical results of cardiac surgery in patients with Essential Thrombocythemia (ET) are rare. In addition, cases of aortic arch aneurysm in ET have not been previously reported. We present a successful aortic valve and arch replacements with the frozen elephant trunk technique using hypothermic circulatory arrest in an ET patient with grade 3 aortic regurgitation and arch aneurysms. Reducing platelet count via the administration of anagrelide and the careful balancing of antiplatelets and anticoagulants is essential in determining the outcome of surgery.

Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)

Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)

The Frozen Elephant Trunk Technique Combined with Beating Heart in Complicated Type B Dissection

The Frozen Elephant Trunk Technique Combined with Beating Heart in Complicated Type B Dissection

Comparison of early outcome between one-stage hybrid technique and frozen elephant thunk technique in the treatment of Stanford A aortic dissection involving the arch

Objective: To analyze the early outcome of one-stage hybrid technique in the treatment of Stanford type-A aortic dissection involving the arch and compare its therapeutic efficacy with the classical frozen elephant trunk technique (FET). Methods: A total of 106 patients with Stanford type-A aortic dissection involving the arch in Department of Cardiac and Vascular Surgery, 1st Affiliated Hospital of Soochow University from October 2015 to October 2019 was collected. All patients in this group were treated with one-stage hybrid technique (modified arch debranching technique) without deep hypothermia circulation. Meanwhile, 30 patients with Stanford type A dissection involving the arch who underwent FET from January 2014 to September 2015 were collected. The therapeutic effects of the two surgical methods were analyzed and compared. Results: The age [M (Q1, Q3)] of 106 patients in hybrid group was 49.0 (40.0, 55.0) years, including 89 males and 17 females. The age [M(Q1, Q3)] of 30 patients in FET group was 49.5 (41.5, 65.3) years, including 24 males and 6 females. The time [M(Q1, Q3)] of using ventilator in hybrid group was 56.0 (38.0, 72.0) h, which was shorter than 127.0 (92.0, 145.0) h in FET group (P<0.001). The incidence of cerebral infarction in hybrid group was 2.8% (3 cases), which was lower than 13.3% (4 cases) in FET group (P=0.042); the incidence of postoperative renal insufficiency in hybrid group was 7.5% (8 cases), which was lower than 23.3% (7 cases) in FET group (P=0.023); the ICU time [M (Q1, Q3)] in hybrid group was 8.0 (6.0, 10.0) d, which was shorter than 14.0 (8.3, 24.0) d in FET group (P<0.001). Conclusion: Compared with FET, one-stage hybrid technology is safer and more effective in the treatment of Stanford type A aortic dissection involving the arch. Its short-term therapeutic efficacy appears good.

The effect of aortic arch replacement on pulse wave velocity after surgery.

OBJECTIVESThe purpose of this study was to investigate the changes in pulse wave velocity (PWV) after aortic arch repair and to evaluate possible perioperative factors associated with an increase in PWV.METHODSEighty-nine patients with preoperative and postoperative PWV measurements who underwent surgical treatment for true aortic arch aneurysm were included in the study. The patients were treated by prosthetic graft replacement with or without the frozen elephant trunk technique or by hybrid surgery with a stent graft. Changes in PWV and perioperative factors were evaluated.RESULTSFifty-one patients were treated by prosthetic graft replacement; 22 patients were treated with the frozen elephant trunk procedure; and 16 patients were treated by hybrid surgery. A significant increase in PWV was observed in patients undergoing surgical treatment for aortic arch aneurysm regardless of the types of operations performed (all treatments: before, 1797 ± 397.8 cm/s vs after, 2061 ± 600.4 cm/s, P < 0.001; graft replacement: before, 1769 ± 398.1 cm/s vs after, 1895 ± 459.0 cm/s, P = 0.004; frozen elephant trunk procedure: before, 1911 ± 461.9 cm/s vs after 2307 ± 826.9 cm/s, P = 0.005; hybrid surgery: before, 1732 ± 273.3 cm/s vs after, 2254 ± 484.6 cm/s, P < 0.001). Differences in PWV were largest in patients treated with hybrid surgery and lowest in those treated with graft replacement (P = 0.002). In univariate analysis, an increase in PWV was positively correlated with treatment length (r = 0.41; P < 0.001); the use of a postoperative beta blocker was associated with a smaller increase in postoperative PWV (with: 165.0 ± 371.92 cm/s vs without: 439.4 ± 530.38 cm/s, P = 0.005). Multivariate analysis suggested that treatment length (coefficient 3.31, 95% confidence interval 0.056–6.562, P = 0.046) and postoperative beta blocker (coefficient −220.08, 95% confidence interval −401.972 to −38.183, P = 0.018) were factors independently associated with changes in PWV.CONCLUSIONSThere was a significant increase in PWV after aortic arch repair. Treatment length and use of postoperative beta blockers were factors associated with changes in postoperative PWV. Minimizing the treatment length and using postoperative beta blockers may attenuate the effects of prostheses on postoperative PWV.

A New Era of Diagnosis and Therapy in Acute Aortic Syndromes: The Mainz–Essen Experience (Part II)—Management and Outcomes

Over 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.

A new dissection-specific hybrid stent graft for patients with DeBakey type I aortic dissection.

We present our first experience of using a new dissection-specific hybrid stent graft (SG) (the 'Soft Elephant Trunk') in the frozen elephant trunk technique, in patients with non-acute DeBakey type I aortic dissection. Between September 2016 and February 2021, patients with non-acute DeBakey type I aortic dissection underwent the frozen elephant trunk procedure at our centre using 3 SG types: group Z used stiff, distal Z-shaped nitinol SGs (E-Vita, Medtronic); group R used a stiff, ring-shaped nitinol SG (Thoraflex); and group S used a soft, distal dissection-specific SG. Predictors of distal SG-induced new entry were analysed. End points were hospital- and midterm-follow-up results. The study comprised 109 patients with 46 (42.2%), 22 (20.2%) and 41 (37.6%) patients in groups Z, R and S, respectively. No significant differences were found in early outcomes. Freedom from distal SG-induced new entry was comparable in groups Z, R and S (68.9% vs 92.9% vs 100%, log-rank = 0.14). There was no significant difference in follow-up between the groups. Four-year survival rates were 80.44%, 71.59% and 95.06% in groups Z, R and S, respectively. On multivariable analysis, the presence of connective tissue disorders [hazard ratio (HR) = 5.62, P = 0.11] and SG diameter (HR = 1.37, P = 0.034) were strong predictors of distal SG-induced new entry. Dissection-specific hybrid SG with a soft distal end is effective in patients with non-acute DeBakey type I aortic dissection. Compared to non-soft distal SGs, this can reduce the incidence of distal complications. Long-term outcomes are necessary to determine the potential advantages and disadvantages of the new prosthesis.

Four-branched graft inversion technique for the distal anastomosis in acute aortic dissection

BackgroundDistal 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.MethodsFrom 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.ResultsThe 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.ConclusionsThe 4-branched graft inversion technique provides effective and confirmed haemostasis during total aortic arch replacement using the frozen elephant trunk procedure.

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

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.

Early and mid-term outcomes of thoracic aortic reconstruction using the frozen elephant trunk technique: A single-center retrospective study

Background. The frozen elephant trunk (FET) technique for the treatment of both thoracic aortic aneurysms and dissections has become universally popular over the past two decades because extensive open surgical reconstruction of the thoracic aorta has been found to be associated with high complication and mortality rates or unfavourable long-term outcomes as it requires repeated interventions. The FET technique has also been shown to produce excellent, immediate and long-term results. Hence, it is important to evaluate the outcomes of thoracic aortic reconstruction using this technique.Aim. This study aimed to investigate immediate and long-term outcomes of the FET technique in patients with thoracic aortic diseases.Methods. We retrospectively analysed the pre-, intra- and post-operative data of 40 patients with distal aortic arch aneurysm who had undergone aortic arch reconstruction using the FET technique at Meshalkin National Research Medical Center from February 2012 to October 2020. To assess the early and long-term post-operative survival of these patients, we categorised them into group I (including 14 patients without aortic dissection) and group II (including 26 patients with type I and type III aortic dissections).Results. The in-hospital survival rates for groups I and II were found to be 68.5% and 95.9%, respectively (log rank, p = 0.048). Groups I and II did not differ significantly in the incidence of stroke (7.1% vs 7.7%, respectively; p = 0.724) and spinal cord ischaemia (14.3% vs 0%, respectively; p = 0.117). Long-term (1-, 3- and 5-year) survival rates in group II remained unchanged at 95.9%, whereas survival rates at 30 days, 6 months and 1 year in group I were 91.3%, 68.5% and 57%, respectively. The risk of mortality was 90% lower in group II than in group I, with a hazard ratio of 0.096 and a 95% confidence interval of 0.01–0.81 (p = 0.038). The rates of freedom from thoracoabdominal aortic interventions in group II were 91.8%, 83%, 64.7%, 59.3% and 59.3% at 30 days, 6 months, 1 year, 3 years and 5 years, respectively; these rates in group I were 90.9%, 75.7% and 75.7% at 30 days, 6 months and 1 year, respectively. There was no significant difference between the groups concerning thoracoabdominal aortic interventions (log rank, p = 0.587).Conclusion. The use of the FET technique in patients with thoracic aortic diseases is associated with acceptable rates of mortality and thoracoabdominal aortic interventions in immediate and long-term post-operative periods.Received 28 January 2021. Revised 28 April 2021. Accepted 29 April 2021.Funding: This work was carried out within the framework of the state task of the Ministry of Health of the Russian Federation (No. 121032300337-5).Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors: The authors contributed equally to this article.

En Bloc Arch Reconstruction With the Frozen Elephant Trunk Technique for Acute Type a Aortic Dissection.

Objective: The study objective was to evaluate the effect of en bloc arch reconstruction with frozen elephant trunk (FET) technique for acute type A aortic dissection.Methods: 41 patients with acute Stanford type A dissection underwent en bloc arch reconstruction combined with FET implantation between April 2018 and August 2020. The mean age of the patients was 46 ± 13 years, and 9 patients were female. One patient had Marfan syndrome. Six patients had pericardial tamponade, 9 had pleural effusion, 5 had transient cerebral ischemic attack, and 3 had chronic kidney disease.Results: The hospital mortality rate was 9.8% (4 patients). 2 (4.9%) patients had stroke, 23 (56.1%) had acute kidney injury, and 5 (12.2%) had renal failure requiring hemodialysis. During follow-up, the rate of complete false lumen thrombosis was 91.6% (33/36) around the FET, 69.4% (25/36) at the diaphragmatic level, and 27.8% (10/36) at the superior mesenteric artery level. The true lumen diameter at the same three levels of the descending aorta increased significantly while the false lumen diameter reduced at the two levels: pulmonary bifurcation and the diaphragm. The 1-, 2-and 3-year actuarial survival rates were 90.2% [95% confidence interval (CI), 81.2–99.2], 84.2% (95% CI, 70.1–98.3) and 70.2% (95% CI, 42.2–98), respectively.Conclusions: In patients with acute type A dissection, en bloc arch reconstruction with FET technique appeared to be feasible and effective with early clinical follow-up results. Future studies including a large sample size and long-term follow-up are required to evaluate the efficacy.

Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique.

Background: This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection.Methods: From February 2009 to December 2019, 79 patients diagnosed with chronic type B or non-A non-B aortic dissection who underwent the FET procedure were included in the present study. We analyzed operation mortality and early and long-term outcomes, including complications, survival and interventions.Results: The operation mortality rate was 5.1% (4/79). Spinal cord injury occurred in 3.8% (3/79), stroke in 2.5% (2/79), and acute renal failure in 5.1% (4/79). The median follow-up time was 53 months. The overall survival rates were 96.2, 92.3, 88.0, 79.8, and 76.2% at 1/2, 1, 3, 5 and 7 years, respectively. Moreover, 79.3% of patients did not require distal aortic reintervention at 7 years. The overall survival in the subacute group was superior to that in the chronic group (P = 0.047).Conclusion: The FET technique is a safe and feasible approach for treating chronic type B and non-A non-B aortic dissection in patients who have contraindications for primary endovascular aortic repair. The technique combines the advantages of both open surgical repair and endovascular intervention, providing comparable early and long-term follow-up outcomes and freedom from reintervention.

Pre-emptive BioGlue priming of the branched Evita Open NEO hybrid prosthesis: tackling excessive oozing.

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.