Multicentre experience with two frozen elephant trunk prostheses in the treatment of acute aortic dissection†

Author:

Berger Tim12,Weiss Gabriel3,Voetsch Andreas4,Arnold Zsuzsanna3,Kreibich Maximilian12,Rylski Bartosz12,Krombholz-Reindl Philipp4,Winkler Andreas4,Mach Markus3,Geisler Daniela3,Seitelberger Rainald4,Siepe Mathias12,Beyersdorf Friedhelm12,Grabenwoeger Martin3,Czerny Martin12,Gottardi Roman4

Affiliation:

1. Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Freiburg, Freiburg, Germany

2. Medical Faculty, Albert Ludwigs-University Freiburg, Freiburg, Germany

3. Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria

4. Department of Cardiovascular Surgery, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, Austria

Abstract

Abstract OBJECTIVES The aim of this study was to evaluate early- and mid-term outcome and aortic remodelling in patients undergoing implantation of 2 different frozen elephant trunk prostheses, either the Thoraflex™ hybrid (Vascutek, Inchinnan, UK) and the E-vita Open (Jotec Inc., Hechingen, Germany) for acute aortic dissection. METHODS All consecutive patients [n = 88; median age 59 (49–67) years; 69% male] undergoing surgery with a frozen elephant trunk prosthesis for acute aortic dissection from August 2005 until March 2018 were included in this study. The Thoraflex™ device was implanted in 55 patients and the E-vita Open graft in 33 patients. RESULTS Preoperative characteristics did not differ significantly between groups. There was also no statistically significant difference in postoperative outcome: in-hospital mortality (11% vs 12%; P > 0.99), stroke (18% vs 6%; P = 0.12) and spinal cord injury (6% vs 6%; P > 0.99). While there was no statistically significant difference in the occurrence of distal stent graft-induced new entries (16% vs 18%; P = 0.77), there was a significantly higher rate of secondary endovascular aortic interventions in the Thoraflex™ hybrid group (22% vs 0%; P = 0.003). There was a trend towards a higher rate of false lumen thrombosis at the level of the stent graft (74% vs 95%; P = 0.085) and was comparable at the thoraco-abdominal transition (53% vs 80%; P = 0.36) 1 year after implantation of the prostheses. CONCLUSIONS In this comparison of 2 frozen elephant trunk prostheses, there is no evidence that different surgical techniques influence in-hospital outcome. At 1-year follow-up, patients who underwent implantation of the E-vita Open prosthesis showed a significantly reduced rate of secondary aortic interventions and a trend towards a higher rate of false lumen thrombosis which might be attributed to a longer coverage of the descending aorta due to a longer stent graft design and significantly more frequent implantation in zone 3.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery

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