scholarly journals Homograft Treatment for Infected Frozen Elephant Trunk Prosthesis

2020 ◽  
Vol 23 (6) ◽  
pp. E786-E788
Author(s):  
Petar Risteski ◽  
Razan Salem ◽  
Thomas Walther ◽  
Johanna Kessel ◽  
Wolf Otto Bechstein
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Tracheoesophageal Fistula ◽  
Muscle Flap ◽  
Total Arch Replacement ◽  
Intercostal Muscle ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Intercostal Muscle Flap

A 46-year-old male received total arch replacement with frozen elephant trunk for acute non-A/non-B aortic dissection. Two months later, he underwent emergency reoperation for contained rupture of the left common carotid ostium at its insertion on the aortic arch. Three months after the reoperation, he developed tracheoesophageal fistula and infection of the prosthesis in the region of the aortic arch and the proximal descending aorta. Second reoperation was performed with replacement of the aorta with a composite of three aortic homografts, and the fistula was permanently closed with a direct suture and intercostal muscle flap

scholarly journals ­­ A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

2020 ◽  
Author(s):  
Shi-bo Song ◽  
Po-yuan Hu ◽  
Xi-jie Wu ◽  
Yong Sun ◽  
Shi-hao Cai ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Short Term ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract Background Acute Stanford type A aortic dissection is a lethal event with a high mortality rate and requires emergency intervention. The goal of salvage surgery is to keep the patient alive by addressing the problems of severe aortic regurgitation, tamponade, primary tear and malperfusion of organs,and, if possible, to prevent the late dissection-related complications in the proximal and downstream aorta. No standard treatment or techniques have been determined for this disease. We aim to describe a modified elephant trunk technique for acute type A aortic dissection and report the short-term outcomes of this surgical technique. Methods From February 2018 to August 2019, 16 patients who were diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique procedure at Xiamen Heart Centre (9men; age, 59.21±11.67 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%)had hypertension and poor blood control management. Operative mortality was 6.25%. The primary tears were located in the lesser curve of the aortic arch in 5 patients (31.3%), in the ascending aorta in 9 patients (56.3%), and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery in 14 patients (87.6%) and to the distal descending aorta in 2 patients (12.5%). The time of cardiopulmonary bypass(CPB),cross-clamping and cerebral perfusion were 215± 40.5,140.8±32.3, and 23±6 minutes, respectively. Aortic valve plasty was performed in 15 patients (93.8%). Additionally, the Bentall procedure and coronary artery repair were performed in 1 patient each (6.3%), respectively. The diameters at all levels were greater before discharge than those when on admission to the hospital, except for the diameter of the aortic arch. After 3 months, the diameters at the aortic arch, descending aorta of the diaphragm, bifurcation of the pulmonary artery had increased, but the diameter at the bifurcation level of the common iliac artery had changed little. Only the diameter of the distal stent aorta had increased significantly. Conclusion The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible, and it could be used for organ malperfusion as well. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

scholarly journals A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Shi-bo Song ◽  
Xi-jie Wu ◽  
Yong Sun ◽  
Shi-hao Cai ◽  
Po-yuan Hu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Short Term ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract Background Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes. Methods From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 56.1 ± 7.6 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB), cross-clamping, and antegrade cerebral perfusion were 215.8 ± 40.5, 140.8 ± 32.3, and 55.1 ± 15.2 min, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling. Conclusions The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

scholarly journals Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections

Aorta ◽  
2018 ◽  
Vol 06 (06) ◽  
pp. 125-129
Author(s):  
Luis López Almodóvar ◽  
Pedro Lima Cañadas ◽  
Andrés Enríquez Puga ◽  
Irene Narváez Mayorga ◽  
José Buendía Miñano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Low Volume

Background Acute Type A aortic dissection (AAAD) is a surgical emergency. In patients with arch and descending aorta involvement (DeBakey Type I), a total aortic arch replacement with frozen elephant trunk (FET) could favor false lumen thrombosis and improve long-term results. The authors hereby present their experience with this technique in a single low-volume center, to assess whether the technique is feasible to treat such disease. Methods From January 2011 to December 2016, 43 patients with AAAD were operated on in the authors' institution, which carries out 300 to 350 annual procedures. Among these, 12 patients with an intimal tear in the aortic arch and/or proximal descending aorta received a FET procedure (10 males, age 57 years). Concomitant procedures were aortic valve replacement (42%), Bentall (25%), and aortic valve repair (17%). Results Cardiopulmonary bypass, cardiac arrest, and circulatory arrest times were 235 ± 43, 171 ± 33, and 75 ± 20 minutes, respectively. The operative mortality was 16.7% (n = 2). Stroke and re-thoracotomy for bleeding occurred in 8% (n = 1) and 8% (n = 1), respectively. There was no spinal cord injury. Follow-up was 36.1 months. During follow-up, no patients died or required a reoperation on the downstream aorta. Conclusion Although all patients were operated on in a low-volume center, the results with FET in AAAD are acceptable. Even though this technique demands high technical skills, it is a promising approach in patients with acute aortic dissection.

scholarly journals ­­ A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

2020 ◽  
Author(s):  
Shi-bo Song ◽  
Po-yuan Hu ◽  
Xi-jie Wu ◽  
Yong Sun ◽  
Shi-hao Cai ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Short Term ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract Background: Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes.Methods: From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 59.21±11.67 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results: Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB)，cross-clamping, and antegrade cerebral perfusion were 215.8± 40.5, 140.8±32.3, and 55.1±15.2 minutes, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling.Conclusions: The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

scholarly journals Total arch replacement and frozen elephant trunk for aortic dissection in aberrant right subclavian artery

2020 ◽  
Vol 58 (1) ◽  
pp. 104-111 ◽  
Author(s):  
Jian-Rong Li ◽  
Wei-Guo Ma ◽  
Yu Chen ◽  
Jun-Ming Zhu ◽  
Jun Zheng ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Subclavian Artery ◽  
Circulatory Arrest ◽  
False Lumen ◽  
Hypothermic Circulatory Arrest ◽  
Total Arch Replacement ◽  
Aberrant Right Subclavian Artery ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Artery Cannulation

Abstract OBJECTIVES Aortic dissection (AoD) in the presence of an aberrant right subclavian artery (ARSA) is very rare. Clinical experience is limited, and there is no consensus regarding the optimal management strategy. We seek to evaluate the safety and efficacy of the total arch replacement (TAR) and frozen elephant trunk (FET) technique as an approach to AoD in patients with ARSA by retrospectively analysing our single-centre experience. METHODS From 2009 to 2017, we performed TAR + FET for 22 patients with ARSA sustaining AoD (13 acute, 59.1%). The mean age was 46.0 years [standard deviation (SD) 8.3], and 19 patients were male (86.4%). ARSA orifice was dilated in 15 (68.2%) patients, and a Kommerall diverticulum was diagnosed in 13 (59.1%) patients with a mean diameter of 21.8 mm (SD 7.7; range 15–40). Surgery was performed via femoral and right/left carotid cannulation under hypothermic circulatory arrest at 25°C. The ARSA was reconstructed using a separate branched graft. RESULTS ARSA was closed proximally by ligation in 16 (72.7%) patients, direct suture in 4 (18.2%) patients and both in 2 (9.1%) patients. Operative mortality was 13.6% (3/22). Type Ib endoleak occurred in 1 (4.5%) patient at 8 days. Follow-up was complete in 100% at mean 4.2 years (SD 2.0), during which 3 late deaths and 1 reintervention for type II endoleak occurred. Survival was 81.8% and 76.4% at 3 and 5 years, respectively. Freedom from reoperation was 89.2% up to 8 years. In competing risks analysis, the incidence was 22.1% for death, 10.8% for reoperation and 67.1% for event-free survival at 5 years. The false lumen, ARSA orifice and Kommerall diverticulum were obliterated in 100%. Grafts were patent in 100%. No patients experienced cerebral ischaemia and upper extremity claudication. Hypothermic circulatory arrest time (min) was sole predictor for death and aortic reintervention (hazard ratio 1.168, 95% confidence interval 1.011–1.348; P = 0.034). CONCLUSIONS The TAR and FET technique is a safe and efficacious approach to AoD in patients with ARSA. Modifications of routine TAR + FET techniques are essential to successful repair, including femoral and right/left carotid artery cannulation, ligation of ARSA on the right side of the trachea and ARSA reconstruction with a separate graft.

scholarly journals Different aortic arch surgery methods for type A aortic dissection: clinical outcomes and follow-up results

2020 ◽  
Vol 31 (2) ◽  
pp. 254-262
Author(s):  
Yunxing Xue ◽  
Jun Pan ◽  
Hailong Cao ◽  
Fudong Fan ◽  
Xuan Luo ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Clinical Outcomes ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Arch Surgery

Abstract OBJECTIVES The aim of this study was to investigate the clinical outcomes and follow-up results among 5 main aortic arch surgery methods for type A aortic dissection in a single centre. METHODS From 2002 to 2018, 958 type A aortic dissection patients who received surgical repair were divided into 5 groups according to the arch surgery method: hemiarch replacement (n = 206), island arch replacement (n = 54), total arch replacement with frozen elephant trunk (n = 425), triple-branched stent (n = 39) and fenestrated stent (n = 234). The indications for the different arch methods were related to the patient’s preoperative status, the location and extent of the dissection and the surgical ability of the surgeons. A comparative study was performed to identify the differences in the perioperative data, and the Kaplan–Meier analysis was used to assess the long-term survival and reintervention rates. Thirty matched surviving patients that were included in each group completed Computed tomography angiography to determine long-term reshaping effect. RESULTS The 30-day mortality rate was 15.8%, and there was no difference among the 5 groups (P = 0.848). The follow-up survival rates were similar among the 5 groups (P = 0.130), and the same was true for patients without reintervention (P = 0.471). In the propensity matching study, patients with stents (frozen elephant trunk, triple-branched stent, fenestrated stent) had a slower aortic dilation rate and a higher ratio of thrombosis in the false lumen at the descending aortic and abdominal aortic levels than patients without stents. CONCLUSIONS No standard method is available for arch surgery, and indications and long-term effects should be identified with clinical data. In our experiences, simpler surgical procedures could reduce mortality in critically ill patients and stents in the distal aorta could improve long-term reshape effects.

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