Christian Detter1, Till Joscha Demal1, Lennart Bax1, Nikolaos Tsilimparis2, Tilo Kölbel2, Yskert von Kodolitsch3, Eik Vettorazzi4, Hermann Reichenspurner1, Jens Brickwedel1. 1. Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany. 2. Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany. 3. Department of General and Interventional Cardiology, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany. 4. Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany.
Abstract
OBJECTIVES: This study aims to analyse the impact of a simplified frozen elephant trunk (FET) technique on early outcome. METHODS: Between October 2010 and August 2018, 92 consecutive patients (mean age 64.4 ± 12.2 years) underwent FET surgery. Underlying pathologies were thoracic aneurysm in 35 patients, acute aortic dissection in 25 patients and chronic dissection in 32 patients. Thirty patients underwent a simplified FET technique with deployment of the stent graft in arch zone 2 with an extra-anatomic bypass to the distal left subclavian artery using the third branch of the Thoraflex™ Hybrid Plexus prosthesis via a supraclavicular access during reperfusion. These patients were compared to 62 patients who received the conventional FET procedure, in which a distal anastomosis is performed in arch zone 3. RESULTS: Circulatory arrest (41.7 ± 10.5 vs 76.5 ± 33.0 min; P < 0.001) and antegrade cerebral perfusion times (60.9 ± 13.5 vs 92.1 ± 33.1 min; P < 0.001) were significantly reduced in zone 2 vs zone 3 patients, respectively. The 30-day mortality rate was 3.3% (n = 1) in zone 2 patients vs 17.7% (n = 11) in zone 3 patients (P = 0.75). Stent deployment in zone 2 was associated with significantly reduced rates of postoperative stroke [zone 2: n = 0 (0.0%); zone 3: n = 11 (17.7%), P = 0.046] and recurrent nerve palsy [zone 2: n = 1 (3.3%); zone 3: n = 14 (22.6%), P = 0.020). CONCLUSIONS: Simplifying the FET procedure leads to reduced circulatory arrest and cerebral perfusion times and improves early outcome.
OBJECTIVES: This study aims to analyse the impact of a simplified frozen elephant trunk (FET) technique on early outcome. METHODS: Between October 2010 and August 2018, 92 consecutive patients (mean age 64.4 ± 12.2 years) underwent FET surgery. Underlying pathologies were thoracic aneurysm in 35 patients, acute aortic dissection in 25 patients and chronic dissection in 32 patients. Thirty patients underwent a simplified FET technique with deployment of the stent graft in arch zone 2 with an extra-anatomic bypass to the distal left subclavian artery using the third branch of the Thoraflex™ Hybrid Plexus prosthesis via a supraclavicular access during reperfusion. These patients were compared to 62 patients who received the conventional FET procedure, in which a distal anastomosis is performed in arch zone 3. RESULTS: Circulatory arrest (41.7 ± 10.5 vs 76.5 ± 33.0 min; P < 0.001) and antegrade cerebral perfusion times (60.9 ± 13.5 vs 92.1 ± 33.1 min; P < 0.001) were significantly reduced in zone 2 vs zone 3 patients, respectively. The 30-day mortality rate was 3.3% (n = 1) in zone 2 patients vs 17.7% (n = 11) in zone 3 patients (P = 0.75). Stent deployment in zone 2 was associated with significantly reduced rates of postoperative stroke [zone 2: n = 0 (0.0%); zone 3: n = 11 (17.7%), P = 0.046] and recurrent nerve palsy [zone 2: n = 1 (3.3%); zone 3: n = 14 (22.6%), P = 0.020). CONCLUSIONS: Simplifying the FET procedure leads to reduced circulatory arrest and cerebral perfusion times and improves early outcome.
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
Authors: Till J Demal; Franziska W Sitzmann; Lennart Bax; Yskert von Kodolitsch; Jens Brickwedel; Johanna Konertz; Daniel M Gaekel; Ahmed J Sadeq; Tilo Kölbel; Eik Vettorazzi; Hermann Reichenspurner; Christian Detter Journal: J Thorac Dis Date: 2022-06 Impact factor: 3.005
Authors: Kristina Mühlstädt; Julie De Backer; Yskert von Kodolitsch; Kerstin Kutsche; Laura Muiño Mosquera; Jens Brickwedel; Evaldas Girdauskas; Thomas S Mir; Adrian Mahlmann; Nikolaos Tsilimparis; Axel Staebler; Lauritz Schoof; Heide Seidel; Jürgen Berger; Alexander M Bernhardt; Stefan Blankenberg; Tilo Kölbel; Christian Detter; Katalin Szöcs; Harald Kaemmerer Journal: J Clin Med Date: 2019-11-29 Impact factor: 4.241