Sergey Leontyev1, Konstantinos Tsagakis2, Davide Pacini3, Roberto Di Bartolomeo3, Friedrich W Mohr4, Gabriel Weiss5, Martin Grabenwoeger5, Jorge G Mascaro6, Mauro Iafrancesco6, Ulrich F Franke7, Nora Göbel7, Thanos Sioris8, Kazimierz Widenka9, Carlos A Mestres10, Heinz Jakob2. 1. Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany sergey.leontyev@medizin.uni-leipzig.de. 2. Department of Thoracic and Cardiovascular Surgery, West German Heart Centre Essen, University Hospital Essen, Essen, Germany. 3. Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 4. Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany. 5. Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria. 6. Queen Elizabeth Hospital Birmingham, Birmingham, UK. 7. Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany. 8. Tampere University Hospital Heart Center, Tampere, Finland. 9. Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland. 10. Department of Cardio Vascular Surgery, Hospital Clinico, University of Barcelona, Barcelona, Spain.
Abstract
OBJECTIVES: The treatment of patients with extensive thoracic aortic disease involving the arch and descending aorta is often performed, using the frozen elephant trunk (FET) technique. We retrospectively analysed early outcomes with this technique, using a prospective database. METHODS: A total of 509 patients (mean age: 61 ± 11 years) were registered between January 2005 and January 2014 in a multicentre database after FET surgery. Acute or chronic aortic dissection (AD) was the indication for surgery in 350 (68.8%) patients and degenerative or atherosclerotic aneurysm (DA) accounted for 159 (31.2%) patients. A logistic regression model was created to identify independent predictors of in-hospital mortality and neurological complications. RESULTS: The average in-hospital mortality was 15.9% (n = 81) with 17.1% for AD patients and 13.2% for DA patients (P = 0.2). Independent predictors of in-hospital mortality were haemodynamic instability [odds ratio (OR): 2.7, P = 0.005], peripheral vascular disease (OR: 2.6, P = 0.002), diabetes (OR: 2.1, P = 0.05) and selective cerebral perfusion time >60 min (OR: 2.2, P = 0.005). Patients under 60 years of age and the use of guide wire during FET implantation were protective for early survival. Stroke occurred in 7.7% (n = 39) of patients. Paraplegia or paraparesis occurred in 7.5% (n = 38) of patients. A distal landing zone lower than T10 was an independent predictor for spinal cord injury (OR: 2.3, P = 0.03). CONCLUSIONS: Techniques for faster arch replacement and controlled FET placement should be considered in order to reduce the early mortality and neurological complications after FET surgery. For distal aortic lesions, a two-staged approach is suggested, rather than the FET landing lower than T10.
OBJECTIVES: The treatment of patients with extensive thoracic aortic disease involving the arch and descending aorta is often performed, using the frozen elephant trunk (FET) technique. We retrospectively analysed early outcomes with this technique, using a prospective database. METHODS: A total of 509 patients (mean age: 61 ± 11 years) were registered between January 2005 and January 2014 in a multicentre database after FET surgery. Acute or chronic aortic dissection (AD) was the indication for surgery in 350 (68.8%) patients and degenerative or atherosclerotic aneurysm (DA) accounted for 159 (31.2%) patients. A logistic regression model was created to identify independent predictors of in-hospital mortality and neurological complications. RESULTS: The average in-hospital mortality was 15.9% (n = 81) with 17.1% for ADpatients and 13.2% for DA patients (P = 0.2). Independent predictors of in-hospital mortality were haemodynamic instability [odds ratio (OR): 2.7, P = 0.005], peripheral vascular disease (OR: 2.6, P = 0.002), diabetes (OR: 2.1, P = 0.05) and selective cerebral perfusion time >60 min (OR: 2.2, P = 0.005). Patients under 60 years of age and the use of guide wire during FET implantation were protective for early survival. Stroke occurred in 7.7% (n = 39) of patients. Paraplegia or paraparesis occurred in 7.5% (n = 38) of patients. A distal landing zone lower than T10 was an independent predictor for spinal cord injury (OR: 2.3, P = 0.03). CONCLUSIONS: Techniques for faster arch replacement and controlled FET placement should be considered in order to reduce the early mortality and neurological complications after FET surgery. For distal aortic lesions, a two-staged approach is suggested, rather than the FET landing lower than T10.
Authors: Maral Ouzounian; Ali Hage; Jennifer Chung; Louis-Mathieu Stevens; Ismail El-Hamamsy; Vincent Chauvette; Francois Dagenais; Andreanne Cartier; Mark Peterson; Alana Harrington; Munir Boodhwani; Ming Guo; John Bozinovski; Stephanie Fox; Linrui Guo; Michael W A Chu Journal: Ann Cardiothorac Surg Date: 2020-05