Author:
Di Marco Luca,Nocera Chiara,Snaidero Silvia,Campanini Francesco,Buia Francesco,Lovato Luigi,Murana Giacomo,Pacini Davide
Abstract
Abstract
Purpose
Frozen elephant trunk (FET) was born as an ideal one-step procedure to treat complex arch and descending thoracic aorta pathology. It was then proved that it frequently needs reintervention, which can often be performed by thoracic endovascular aortic repair (TEVAR) extension since FET provides a safe proximal landing zone. We hereby describe our experience in TEVAR extension after FET, its main indications, technique, and outcomes.
Methods
Between 2007 and 2022, 371 patients underwent FET at our center. Of these, 119 needed TEVAR extension. Some required more than one TEVAR, with a total of 154 procedures. The preoperative characteristics, indications, and outcomes were analyzed retrospectively.
Results
Of 154 TEVAR procedures, 15 were performed in an urgent setting. Mean time from FET to TEVAR was 22,2 ± 28,73 months. Two patients died in the operating room; no others died during the hospital stay. Survival after 1, 2, 5, and 10 years was 96.2%, 93.9%, 90.1%, and 70.5% respectively. There was no statistically significant difference in the rates of TEVAR extension for patients in which a Thoraflex™ vs E-vita™ graft was used, nor for zone 2 vs zone 3 anastomosis and stent length.
Conclusion
Though TEVAR extension is often required after FET, it is a safe and effective procedure with excellent post-operative outcomes in the short-, mid-, and long-term and allows successful treatment of complex aortic pathologies. Rigorous and specialized follow-up after FET is central to identify the right moment to intervene.
Funder
Alma Mater Studiorum - Università di Bologna
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,Surgery
Reference37 articles.
1. Shrestha M, Bachet J, Bavaria J, Carrel TP, De Paulis R, Di Bartolomeo R, et al. Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS. Eur J Cardiothorac Surg. 2015;47:759–69.
2. Leone A, Di Marco L, Coppola G, Amodio C, Berardi M, Mariani C, et al. Open distal anastomosis in the frozen elephant trunk technique: initial experiences and preliminary results of arch zone 2 versus arch zone 3. Eur J Cardiothorac Surg. 2019;56:564–71.
3. Preventza O, Liao JL, Olive JK, Simpson K, Critsinelis AC, Price MD, et al. Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients. J Thorac Cardiovasc Surg. 2020;160:20-33.e4. https://doi.org/10.1016/j.jtcvs.2019.10.031.
4. Liebrich M, Charitos EI, Schlereth S, Meißner H, Trabold T, Geisbüsch P, et al. 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. Eur J Cardiothorac Surg. 2021;60:343–51.
5. Di Eusanio M, Armaro A, Di Marco L, Pacini D, Savini C, Martin Suarez S, et al. Short- and midterm results after hybrid treatment of chronic aortic dissection with the frozen elephant trunk technique. Eur J Cardiothorac Surg. 2011;40:875–80.