Eric E Roselli1, Jay J Idrees2, Faisal G Bakaeen2, Michael Z Tong2, Edward G Soltesz2, Stephanie Mick2, Douglas R Johnston2, Mathew J Eagleton3, Venu Menon4, Lars G Svensson2. 1. Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: roselle@ccf.org. 2. Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 3. Department of Vascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 4. Department of Cardiovascular Medicine, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: A modified technique for frozen elephant trunk (FET) repair of acute DeBakey type I dissection has evolved. Procedural modifications are described and midterm outcomes evaluated. METHODS: From 2009 to 2016, 72 patients with DeBakey type I dissection underwent emergency simplified FET. Mean age was 59 ± 15 years. Presentation included malperfusion (n = 22, 31%), rupture (n = 12, 16%), and aortic insufficiency (n = 42, 58%). Concomitant procedures included valve replacement (n = 9), root replacement (n = 11; valve sparing n = 6), cusp repair (n = 11), and valve resuspension (n = 21). The first 39 were treated by modifying an early generation stent graft. The next 16 received newer modified stent grafts, and the latest 17 underwent branched single anastomosis technique with left subclavian stent grafting. RESULTS: Operative mortality was 4.2% (n = 3 of 72). Two presented comatose without recovering, the other died from coagulopathy complications. Morbidity included stroke (n = 3, 4.2%), spinal injury (n = 3, 4.2%; 1 permanent), tracheostomy (n = 7, 9.7%), and renal failure (n = 2, 2.8%). Median follow-up was 28 ± 25 months. Survival was 92% at 6 months, 92% at 1 year, 89% at 3 years, and 80% at 5 years. Among 69 survivors, follow-up imaging was available in 63 (91%). Of these, 58 (92%) patients thrombosed the treated false lumen, with shrinkage in 37(54%) patients from 42 ± 8 mm to 37 ± 7 mm. Ten patients underwent 14 late reinterventions for growth and incomplete thrombosis (7 endo extension, 4 left subclavian embolization, 1 bypass, 2 false lumen embolization). Freedom from reintervention was 93% at 6 months, 87% at 1 year, 77% at 3 years, and 72% at 5 years. CONCLUSIONS: Simplified FET for treating acute DeBakey type I dissection has evolved and remained safe. It promotes aortic remodeling, and simplifies management of chronic aortic complications.
BACKGROUND: A modified technique for frozen elephant trunk (FET) repair of acute DeBakey type I dissection has evolved. Procedural modifications are described and midterm outcomes evaluated. METHODS: From 2009 to 2016, 72 patients with DeBakey type I dissection underwent emergency simplified FET. Mean age was 59 ± 15 years. Presentation included malperfusion (n = 22, 31%), rupture (n = 12, 16%), and aortic insufficiency (n = 42, 58%). Concomitant procedures included valve replacement (n = 9), root replacement (n = 11; valve sparing n = 6), cusp repair (n = 11), and valve resuspension (n = 21). The first 39 were treated by modifying an early generation stent graft. The next 16 received newer modified stent grafts, and the latest 17 underwent branched single anastomosis technique with left subclavian stent grafting. RESULTS: Operative mortality was 4.2% (n = 3 of 72). Two presented comatose without recovering, the other died from coagulopathy complications. Morbidity included stroke (n = 3, 4.2%), spinal injury (n = 3, 4.2%; 1 permanent), tracheostomy (n = 7, 9.7%), and renal failure (n = 2, 2.8%). Median follow-up was 28 ± 25 months. Survival was 92% at 6 months, 92% at 1 year, 89% at 3 years, and 80% at 5 years. Among 69 survivors, follow-up imaging was available in 63 (91%). Of these, 58 (92%) patients thrombosed the treated false lumen, with shrinkage in 37(54%) patients from 42 ± 8 mm to 37 ± 7 mm. Ten patients underwent 14 late reinterventions for growth and incomplete thrombosis (7 endo extension, 4 left subclavian embolization, 1 bypass, 2 false lumen embolization). Freedom from reintervention was 93% at 6 months, 87% at 1 year, 77% at 3 years, and 72% at 5 years. CONCLUSIONS: Simplified FET for treating acute DeBakey type I dissection has evolved and remained safe. It promotes aortic remodeling, and simplifies management of chronic aortic complications.
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
Authors: Erik Beckmann; Andreas Martens; Wilhelm Korte; Tim Kaufeld; Heike Krueger; Axel Haverich; Malakh Shrestha Journal: Ann Cardiothorac Surg Date: 2020-05
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