Maximilian Kreibich1, Tim Berger2, Bartosz Rylski2, Zehang Chen2, Friedhelm Beyersdorf2, Matthias Siepe2, Martin Czerny2. 1. Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: maximilian.kreibich@universitaets-herzzentrum.de. 2. Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Abstract
OBJECTIVE: The frozen elephant trunk (FET) procedure has emerged as a potential single-step treatment for pathologies of the thoracic aorta, but the procedure's true potential to be a single-step treatment remains unclear. The aim of this study was to evaluate the need and outcomes of aortic reinterventions after previous FET implantation. METHODS: Patient characteristics and follow-up data of 107 patients following the FET procedure were evaluated and compared between patients with and without aortic reinterventions. A competing risk regression model was analyzed to identify independent predictors of aortic reintervention and to predict the risk for reintervention. RESULTS: Intended completion, anticipated reinterventions, and unexpected reinterventions were performed in 35 patients (33%). There was no difference in the underlying pathology between patients with or without aortic reintervention. An endovascular reintervention was performed in 24 patients (69%), open surgery in 7 patients (20%) and a hybrid approach in 4 patients (11%). No stroke or permanent spinal cord injuries were observed. In-hospital mortality after reintervention was 14% (5 patients), but there was no difference in survival during follow-up after FET implantation (log rank test, P = .58). No risk factors for aortic reinterventions were identified. The risk for aortic reintervention was 31% (95% confidence interval [CI], 21%-42%), 49% (95% CI, 35%-62%), and 64% (95% CI, 44%-79%) after 12, 24, and 36 months, respectively. CONCLUSIONS: Aortic reinterventions are common and likely after FET implantation, but this study did not identify independent predictors. Reinterventions are associated with acceptable morbidity and mortality. Close follow-up of all patients undergoing FET procedure is paramount.
OBJECTIVE: The frozen elephant trunk (FET) procedure has emerged as a potential single-step treatment for pathologies of the thoracic aorta, but the procedure's true potential to be a single-step treatment remains unclear. The aim of this study was to evaluate the need and outcomes of aortic reinterventions after previous FET implantation. METHODS:Patient characteristics and follow-up data of 107 patients following the FET procedure were evaluated and compared between patients with and without aortic reinterventions. A competing risk regression model was analyzed to identify independent predictors of aortic reintervention and to predict the risk for reintervention. RESULTS: Intended completion, anticipated reinterventions, and unexpected reinterventions were performed in 35 patients (33%). There was no difference in the underlying pathology between patients with or without aortic reintervention. An endovascular reintervention was performed in 24 patients (69%), open surgery in 7 patients (20%) and a hybrid approach in 4 patients (11%). No stroke or permanent spinal cord injuries were observed. In-hospital mortality after reintervention was 14% (5 patients), but there was no difference in survival during follow-up after FET implantation (log rank test, P = .58). No risk factors for aortic reinterventions were identified. The risk for aortic reintervention was 31% (95% confidence interval [CI], 21%-42%), 49% (95% CI, 35%-62%), and 64% (95% CI, 44%-79%) after 12, 24, and 36 months, respectively. CONCLUSIONS: Aortic reinterventions are common and likely after FET implantation, but this study did not identify independent predictors. Reinterventions are associated with acceptable morbidity and mortality. Close follow-up of all patients undergoing FET procedure is paramount.
Authors: Maximilian Kreibich; Tim Berger; Tim Walter; Paul Potratz; Philipp Discher; Stoyan Kondov; Friedhelm Beyersdorf; Matthias Siepe; Roman Gottardi; Martin Czerny; Bartosz Rylski Journal: Cardiovasc Diagn Ther Date: 2022-06
Authors: Tim Berger; Miriam Graap; Bartosz Rylski; Albi Fagu; Roman Gottardi; Tim Walter; Philipp Discher; Muhammad Taha Hagar; Stoyan Kondov; Martin Czerny; Maximilian Kreibich Journal: Front Cardiovasc Med Date: 2022-06-06
Authors: Tim Walter; Tim Berger; Stoyan Kondov; Roman Gottardi; Julia Benk; Bartosz Rylski; Martin Czerny; Maximilian Kreibich Journal: Front Cardiovasc Med Date: 2022-06-30
Authors: Matti Jubouri; Fatima Kayali; Priyanshu Saha; Daniyal M Ansari; Yousef Rezaei; Sven Z C P Tan; Mostafa Mousavizadeh; Saeid Hosseini; Idhrees Mohammed; Mohamad Bashir Journal: Front Cardiovasc Med Date: 2022-03-10