Maximilian Kreibich1, Dennis Bünte2, Tim Berger3, Andreas Vötsch4, Bartosz Rylski3, Philipp Krombholz-Reindl4, Zehang Chen3, Julia Morlock3, Friedhelm Beyersdorf3, Andreas Winkler4, Bernd Rolauffs2, Matthias Siepe3, Roman Gottardi4, Martin Czerny3. 1. Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany. Electronic address: maximilian.kreibich@universitaets-herzzentrum.de. 2. GERN Center for Tissue Replacement, Regeneration, and Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert Ludwig University of Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany. 3. Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany. 4. Department of Cardiac Surgery, Paracelsus Medical University, Salzburg, Austria.
Abstract
BACKGROUND: This study sought to evaluate the incidence of and identify risk factors for distal stent graft-induced new entries (dSINEs) after the frozen elephant trunk (FET) procedure. METHODS: Patient characteristics and radiographic and follow-up data on 126 patients treated for aortic dissections with the Thoraflex (Vascutek Ltd, Inchinnan, United Kingdom) FET device in 2 centers between November 2013 and December 2018 were evaluated. Stress-strain behavior and load-displacement curves of the Thoraflex and the E-Vita Open (Jotec Inc, Hechingen, Germany) FET prosthesis were evaluated by applying axial load to the most distal ring of the prostheses. RESULTS: dSINEs were diagnosed in 16 patients (13%). There was no difference in the underlying disease, aortic features, or FET stent graft dimension between patients with and without dSINEs. No predictors for dSINE occurrence in patients treated with the Thoraflex device were identified. The risk for dSINE development was 14% (95% confidence interval [CI], 0% to 22%), 16% (95% CI, 0% to 24%), and 25% (95% CI, 0% to 45%) after 12, 24, and 36 months, respectively. When prostheses were loaded axially to 2-mm maximal displacement, the Thoraflex prosthesis exhibited strongly nonlinear behavior with maximal stiffness for minimal displacements, whereas the E-Vita prosthesis showed nearly constant stiffness. In addition, the Thoraflex prosthesis showed an increase in stiffness when confined. CONCLUSIONS: dSINEs may develop at any time after the FET procedure, and the risk for dSINE development is high. No clinical or patient-specific risk factors were identified in this study. The design of the Thoraflex graft with a stiff distal ring may be a potential reason for the occurrence of dSINEs.
BACKGROUND: This study sought to evaluate the incidence of and identify risk factors for distal stent graft-induced new entries (dSINEs) after the frozen elephant trunk (FET) procedure. METHODS:Patient characteristics and radiographic and follow-up data on 126 patients treated for aortic dissections with the Thoraflex (Vascutek Ltd, Inchinnan, United Kingdom) FET device in 2 centers between November 2013 and December 2018 were evaluated. Stress-strain behavior and load-displacement curves of the Thoraflex and the E-Vita Open (Jotec Inc, Hechingen, Germany) FET prosthesis were evaluated by applying axial load to the most distal ring of the prostheses. RESULTS:dSINEs were diagnosed in 16 patients (13%). There was no difference in the underlying disease, aortic features, or FET stent graft dimension between patients with and without dSINEs. No predictors for dSINE occurrence in patients treated with the Thoraflex device were identified. The risk for dSINE development was 14% (95% confidence interval [CI], 0% to 22%), 16% (95% CI, 0% to 24%), and 25% (95% CI, 0% to 45%) after 12, 24, and 36 months, respectively. When prostheses were loaded axially to 2-mm maximal displacement, the Thoraflex prosthesis exhibited strongly nonlinear behavior with maximal stiffness for minimal displacements, whereas the E-Vita prosthesis showed nearly constant stiffness. In addition, the Thoraflex prosthesis showed an increase in stiffness when confined. CONCLUSIONS:dSINEs may develop at any time after the FET procedure, and the risk for dSINE development is high. No clinical or patient-specific risk factors were identified in this study. The design of the Thoraflex graft with a stiff distal ring may be a potential reason for the occurrence of dSINEs.
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: I Yu Zhuravleva; T P Timchenko; S V Vladimirov; M M Lyashenko; E V Kuznetsova; A M Chernyavskiy Journal: Sovrem Tekhnologii Med Date: 2021-02-28
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