Gabriel Weiss1, Konstantinos Tsagakis2, Heinz Jakob2, Roberto Di Bartolomeo3, Davide Pacini3, Giuseppe Barberio3, Jorge Mascaro4, Carlos-A Mestres5, Thanos Sioris6, Martin Grabenwoger7. 1. Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria gabrielweiss@me.com. 2. Department of Cardiac Surgery, University Hospital Essen, Essen, Germany. 3. Department of Cardiovascular Surgery, University Bologna, Bologna, Italy. 4. Department of Cardiac Surgery, University Birmingham, Birmingham, UK. 5. Hospital Clinico, University Barcelona, Barcelona, Spain. 6. Department of Cardiac Surgery, University Tampere, Tampere, Finland. 7. Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria.
Abstract
OBJECTIVES: Providing effective treatment for complicated type B aortic dissection (AD) with concomitant pathologies of the aortic arch or ascending aorta is challenging, especially if the aortic anatomy is contraindicated for thoracic endovascular aortic repair (TEVAR). We present the early results of a multicentre study using the frozen elephant trunk (FET) technique for type B AD. METHODS: From January 2005 to March 2013, data from 465 patients who had undergone treatment with the FET technique were collected in the database of the International E-vita Open Registry. From this cohort, 57 patients who had a primary indication for surgery for type B AD were included in the present study. Their mean age was 58±12 years, and 72% had a chronic dissection. All operations were performed in circulatory arrest and bilateral antegrade cerebral perfusion. Computed aortic imaging was performed for false lumen (FL) evaluation during the follow-up. RESULTS: The in-hospital mortality rate was 14% (8/57). Stroke and spinal cord injury occurred in 6 (10%) and 2 patients (4%), respectively. The rate of immediate FL thrombosis at the level of the stent graft was 75% (40/53) and increased to 97% (41/42) during the follow-up period (23±19 months). Distally, at the level of the abdominal aorta, the FL remained patent in 50% (21/42) of patients. The 1- and 3-year survival was 81 and 75%, respectively. CONCLUSION: The FET technique is a feasible therapeutic option for complicated type B AD with involvement of the aortic arch if TEVAR is contraindicated. In contrast to conventional aortic surgery via a lateral thoracotomy, the FET procedure can provide simultaneous treatment of the ascending aorta and aortic arch.
OBJECTIVES: Providing effective treatment for complicated type B aortic dissection (AD) with concomitant pathologies of the aortic arch or ascending aorta is challenging, especially if the aortic anatomy is contraindicated for thoracic endovascular aortic repair (TEVAR). We present the early results of a multicentre study using the frozen elephant trunk (FET) technique for type B AD. METHODS: From January 2005 to March 2013, data from 465 patients who had undergone treatment with the FET technique were collected in the database of the International E-vita Open Registry. From this cohort, 57 patients who had a primary indication for surgery for type B AD were included in the present study. Their mean age was 58±12 years, and 72% had a chronic dissection. All operations were performed in circulatory arrest and bilateral antegrade cerebral perfusion. Computed aortic imaging was performed for false lumen (FL) evaluation during the follow-up. RESULTS: The in-hospital mortality rate was 14% (8/57). Stroke and spinal cord injury occurred in 6 (10%) and 2 patients (4%), respectively. The rate of immediate FLthrombosis at the level of the stent graft was 75% (40/53) and increased to 97% (41/42) during the follow-up period (23±19 months). Distally, at the level of the abdominal aorta, the FL remained patent in 50% (21/42) of patients. The 1- and 3-year survival was 81 and 75%, respectively. CONCLUSION: The FET technique is a feasible therapeutic option for complicated type B AD with involvement of the aortic arch if TEVAR is contraindicated. In contrast to conventional aortic surgery via a lateral thoracotomy, the FET procedure can provide simultaneous treatment of the ascending aorta and aortic arch.
Authors: Martin Grabenwöger; Markus Mach; Heinrich Mächler; Zsuzsanna Arnold; Harald Pisarik; Sandra Folkmann; Marie-Luise Harrer; Daniela Geisler; Reinhard Moidl; Bernhard Winkler; Johannes Bonatti; Martin Czerny; Gabriel Weiss Journal: Eur J Cardiothorac Surg Date: 2021-06-14 Impact factor: 4.191
Authors: Nicholas A Vernice; Matthew E Wingo; Paul B Walker; Michelle Demetres; Lily N Stalter; Qiuyu Yang; Andreas R de Biasi Journal: J Card Surg Date: 2022-05-08 Impact factor: 1.778
Authors: Cristina-Maria Șulea; Csaba Csobay-Novák; Zoltán Oláh; Péter Banga; Zoltán Szeberin; Ádám Soltész; Zsófia Jokkel; Kálmán Benke; Máté Csonka; Eperke Dóra Merkel; Béla Merkely; Zoltán Szabolcs; Miklós Pólos Journal: J Cardiovasc Dev Dis Date: 2022-09-06