Daniel-Sebastian Dohle1, Konstantinos Tsagakis2, Rolf Alexander Janosi3, Jaroslav Benedik2, Hilmar Kühl4, Liuba Penkova2, Ferdinand Stebner5, Daniel Wendt2, Heinz Jakob2. 1. Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, Essen, Germany ds.dohle@uk-essen.de. 2. Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, Essen, Germany. 3. Department of Cardiology, West German Heart Center, University of Duisburg-Essen, Essen, Germany. 4. Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany. 5. Department of Research on Learning and Instruction, Institute of Educational Science, Ruhr-University Bochum, Bochum, Germany.
Abstract
OBJECTIVES: Frozen elephant trunk (FET) can be used for continuous downstream aorta treatment in acute aortic dissection (AAD) and chronic aortic dissection (CAD). The study reports the changes in the lumen volumes along the downstream aorta towards remodelling. METHODS: In 70 patients (22 CAD, 48 AAD), pre-, postoperative and at least the 1-year follow-up aortic imaging was available. Volume changes of aortic lumen (AL) and true lumen (TL) between examinations along the stent graft aortic segment (A), downstream to coeliac trunk (B) and distally to bifurcation (C) were used for quantification. TL increase >10% with stable AL or AL decrease >10% with stable TL were classified as positive, changes within a 10% threshold as stable, and all other changes as negative remodelling. RESULTS: In AAD, positive or stable remodelling occurred in A (90%), B (65%), C (58%) within 1 year, thereafter in 26 patients (follow-up: 47 ± 21 months) in A (92%), B (65%), C (62%). Negative remodelling in ≥2 segments was found in 5/26 (19%) patients. In CAD, positive or stable remodelling occurred in A (100%), B (86%), C (77%) within 1 year, thereafter in 16 patients (follow-up: 46 ± 20 months) in A (75%), B (44%), C (38%). Negative remodelling in ≥2 segments was found in 7/16 (43%) patients, 5 underwent reintervention, and stabilized thereafter. CONCLUSIONS: FET facilitates positive remodelling in AAD and CAD down to stent graft level. Distally, 20% AAD and 40% CAD patients remain at risk for secondary reintervention, and can be identified by negative remodelling in ≥2 segments in the follow-up examinations.
OBJECTIVES: Frozen elephant trunk (FET) can be used for continuous downstream aorta treatment in acute aortic dissection (AAD) and chronic aortic dissection (CAD). The study reports the changes in the lumen volumes along the downstream aorta towards remodelling. METHODS: In 70 patients (22 CAD, 48 AAD), pre-, postoperative and at least the 1-year follow-up aortic imaging was available. Volume changes of aortic lumen (AL) and true lumen (TL) between examinations along the stent graft aortic segment (A), downstream to coeliac trunk (B) and distally to bifurcation (C) were used for quantification. TL increase >10% with stable AL or AL decrease >10% with stable TL were classified as positive, changes within a 10% threshold as stable, and all other changes as negative remodelling. RESULTS: In AAD, positive or stable remodelling occurred in A (90%), B (65%), C (58%) within 1 year, thereafter in 26 patients (follow-up: 47 ± 21 months) in A (92%), B (65%), C (62%). Negative remodelling in ≥2 segments was found in 5/26 (19%) patients. In CAD, positive or stable remodelling occurred in A (100%), B (86%), C (77%) within 1 year, thereafter in 16 patients (follow-up: 46 ± 20 months) in A (75%), B (44%), C (38%). Negative remodelling in ≥2 segments was found in 7/16 (43%) patients, 5 underwent reintervention, and stabilized thereafter. CONCLUSIONS: FET facilitates positive remodelling in AAD and CAD down to stent graft level. Distally, 20% AAD and 40% CAD patients remain at risk for secondary reintervention, and can be identified by negative remodelling in ≥2 segments in the follow-up examinations.
Authors: Martin Czerny; Maximilian Kreibich; Julia Morlock; Stoyan Kondov; Johannes Scheumann; Holger Schröfel; Fabian A Kari; Tim Berger; Matthias Siepe; Friedhelm Beyersdorf; Bartosz Rylski Journal: J Vis Surg Date: 2018-01-17
Authors: Konstantinos Tsagakis; Davide Pacini; Martin Grabenwöger; Michael A Borger; Nora Goebel; Wolfgang Hemmer; Alvaro Laranjeira Santos; Thanos Sioris; Kazimierz Widenka; Petar Risteski; Jorge Mascaro; Igor Rudez; Andreas Zierer; Carlos A Mestres; Arjang Ruhparwar; Roberto Di Bartolomeo; Heinz Jakob Journal: Ann Cardiothorac Surg Date: 2020-05