Publicação
Frozen elephant trunk technique : review & single-center study short- and midterm results
| Resumo: | Background: The surgical treatment of diffuse pathologies of the thoracic aorta remains a challenging issue in aortic surgery. Recently, a hybrid repair combining antegrade stenting vascular treatment with conventional arch replacement surgery, the so-called ‘frozen elephant trunk’ (FET) technique, has been used as a one or two-stage procedure. In this study, with a short series, we report the early experience of our center (Santa Maria Hospital - Cardiothoracic Surgery Department – Lisbon), including the short- and midterm results after hybrid treatment with the FET technique, using the E-vita open plus prosthesis (JOTEC®). Methods: From January 2012 to March 2015, 7 patients (male: 57,3% mean age: 53 ± 14,9 years) were operated on for complex pathologies of the thoracic aorta using the FET technique. The indications for surgery included four (57,1%) with chronic degenerative aneurysm, one patient (14,3%) with type A chronic dissection, one (14,3%) patient with Type B dissection and one (14,3%) case of acute type A. Two patients (28,6%) had undergone previous aortic or cardiac surgery and three patients (42,9%) underwent Bentall concomitant procedure. Results: Overall, no (0%) in-hospital or 30-day mortality was observed. SCI (paraplegia/paraparesis) occurred in only one patient (14,3%) and PND (stroke or coma) in none (0%). There were one case (14,3%) of bleeding with re-sternotomy, one case (14,3%) of respiratory failure and one case (14,3%) of renal failure. For the surviving patients, 1- and 2-year freedom from all-cause mortality was 100%. Three TEVAR were performed (42,9%) as a second stage aortic extension with 100% technical success rate. The ICU stay and the Hospital stay were 5 ± 3,6 and 8 ± 1,3 days respectively. Conclusions: In our experience, FET surgery allowed treatment of complex patients with extensive thoracic aortic diseases with satisfactory short- and mid-term results in line with case series reported in the literature. The FET procedure can be performed with a relatively low mortality and morbidity, but is associated with an increased incidence of ischaemic SCI. Larger and longer-term studies are required to show the survival benefits of the FET technique in our center. New strategies for SCI reduction should also be researched. |
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| Autores principais: | Gonçalves, João David Barroso |
| Assunto: | Aorta Frozen elephant trunk E-vita open plus prosthesis |
| Ano: | 2015 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso restrito |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Background: The surgical treatment of diffuse pathologies of the thoracic aorta remains a challenging issue in aortic surgery. Recently, a hybrid repair combining antegrade stenting vascular treatment with conventional arch replacement surgery, the so-called ‘frozen elephant trunk’ (FET) technique, has been used as a one or two-stage procedure. In this study, with a short series, we report the early experience of our center (Santa Maria Hospital - Cardiothoracic Surgery Department – Lisbon), including the short- and midterm results after hybrid treatment with the FET technique, using the E-vita open plus prosthesis (JOTEC®). Methods: From January 2012 to March 2015, 7 patients (male: 57,3% mean age: 53 ± 14,9 years) were operated on for complex pathologies of the thoracic aorta using the FET technique. The indications for surgery included four (57,1%) with chronic degenerative aneurysm, one patient (14,3%) with type A chronic dissection, one (14,3%) patient with Type B dissection and one (14,3%) case of acute type A. Two patients (28,6%) had undergone previous aortic or cardiac surgery and three patients (42,9%) underwent Bentall concomitant procedure. Results: Overall, no (0%) in-hospital or 30-day mortality was observed. SCI (paraplegia/paraparesis) occurred in only one patient (14,3%) and PND (stroke or coma) in none (0%). There were one case (14,3%) of bleeding with re-sternotomy, one case (14,3%) of respiratory failure and one case (14,3%) of renal failure. For the surviving patients, 1- and 2-year freedom from all-cause mortality was 100%. Three TEVAR were performed (42,9%) as a second stage aortic extension with 100% technical success rate. The ICU stay and the Hospital stay were 5 ± 3,6 and 8 ± 1,3 days respectively. Conclusions: In our experience, FET surgery allowed treatment of complex patients with extensive thoracic aortic diseases with satisfactory short- and mid-term results in line with case series reported in the literature. The FET procedure can be performed with a relatively low mortality and morbidity, but is associated with an increased incidence of ischaemic SCI. Larger and longer-term studies are required to show the survival benefits of the FET technique in our center. New strategies for SCI reduction should also be researched. |
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