Michael W A Chu1, Katie L Losenno2, Luc A Dubois3, Philip M Jones4, Maral Ouzounian5, Richard Whitlock6, Francois Dagenais7, Munir Boodhwani8, Gopal Bhatnagar9, Ahmad Poostizadeh10, Zlatko Pozeg11, Michael Moon12, Bob Kiaii2, Mark D Peterson13. 1. Division of Cardiac Surgery, Western University, Lawson Health Research Institute, London, Ontario, Canada. Electronic address: michael.chu@lhsc.on.ca. 2. Division of Cardiac Surgery, Western University, Lawson Health Research Institute, London, Ontario, Canada. 3. Division of Vascular Surgery, Western University, Lawson Health Research Institute, London, Ontario, Canada. 4. Department of Anesthesia and Perioperative Medicine, and Department of Epidemiology and Biostatistics, Western University, Lawson Health Research Institute, London, Ontario, Canada. 5. Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. 6. Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada. 7. Division of Cardiac Surgery, University of Laval, Quebec City, Quebec, Canada. 8. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 9. Trillium Cardiovascular Associates, Mississauga, Ontario, Canada. 10. Division of Cardiac Surgery, University of British Columbia, Kelowna, British Columbia, Canada. 11. Division of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. 12. Division of Cardiac Surgery, University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada. 13. Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Hybrid aortic arch surgery has evolved to include several technical variations, with most including an off-label use of a conventional thoracic endograft. We describe the early clinical outcomes of the Thoraflex Hybrid graft (Vascutek, Glasgow, Scotland) specifically designed for the treatment of complex arch and proximal descending aortic disease. METHODS: Between January 2014 and April 2017, 40 consecutive patients (66 ± 14 years of age, 45% women) underwent hybrid aortic arch and frozen elephant trunk repair with the multibranched Thoraflex Hybrid graft at 9 Canadian centers. Surgical indications included transverse arch or proximal descending aortic aneurysm in 100%, acute dissection in 10%, chronic dissection in 43%, and acute aortic rupture in 1 patient. Antegrade cerebral perfusion and moderate hypothermia (24.3 ± 1.8°C) were employed in all cases. RESULTS: All 40 device implants were successful. The 30-day or in-hospital mortality was 5%. Stroke and transient neurological deficits occurred in 5% and 3% of patients, respectively. Two (5%) patients experienced transient spinal cord ischemia-there were no instances of permanent paraplegia. Mean follow-up was 550 ± 328 days and late complications included type A aortic dissection in 1 patient, type B dissection in 2 patients, and further distal endografting in 2 patients. Survival at 30 days, 1 year, and 2 years was 95%, 95%, and 90%, respectively. CONCLUSIONS: Hybrid aortic arch and frozen elephant trunk repair with the Thoraflex Hybrid graft appears to be associated with good clinical outcomes, despite being early in the learning curve with this graft. Further investigation with this device is warranted to establish its role within the variations of hybrid arch repair.
BACKGROUND: Hybrid aortic arch surgery has evolved to include several technical variations, with most including an off-label use of a conventional thoracic endograft. We describe the early clinical outcomes of the Thoraflex Hybrid graft (Vascutek, Glasgow, Scotland) specifically designed for the treatment of complex arch and proximal descending aortic disease. METHODS: Between January 2014 and April 2017, 40 consecutive patients (66 ± 14 years of age, 45% women) underwent hybrid aortic arch and frozen elephant trunk repair with the multibranched Thoraflex Hybrid graft at 9 Canadian centers. Surgical indications included transverse arch or proximal descending aortic aneurysm in 100%, acute dissection in 10%, chronic dissection in 43%, and acute aortic rupture in 1 patient. Antegrade cerebral perfusion and moderate hypothermia (24.3 ± 1.8°C) were employed in all cases. RESULTS: All 40 device implants were successful. The 30-day or in-hospital mortality was 5%. Stroke and transient neurological deficits occurred in 5% and 3% of patients, respectively. Two (5%) patients experienced transient spinal cord ischemia-there were no instances of permanent paraplegia. Mean follow-up was 550 ± 328 days and late complications included type A aortic dissection in 1 patient, type B dissection in 2 patients, and further distal endografting in 2 patients. Survival at 30 days, 1 year, and 2 years was 95%, 95%, and 90%, respectively. CONCLUSIONS: Hybrid aortic arch and frozen elephant trunk repair with the Thoraflex Hybrid graft appears to be associated with good clinical outcomes, despite being early in the learning curve with this graft. Further investigation with this device is warranted to establish its role within the variations of hybrid arch repair.
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