David H Tian1,2, Hakeem Ha1, Yashutosh Joshi1, Tristan D Yan1,3. 1. Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia. 2. Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia. 3. Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Abstract
BACKGROUND: The frozen elephant trunk (FET) procedure remains an increasingly popular approach to address complex multi-segmental aortic pathologies, owing to their ability to promote false lumen thrombosis and reduce the need for second-stage operations. While the short-term outcomes of such procedures have been shown to be acceptable, much less is known regarding long-term outcomes. This systematic review evaluates long-term outcomes of the FET procedure. METHODS: Studies with at least 12 months follow-up data on FETs were identified in four electronic databases. All studies were reviewed by two independent researchers and relevant data extracted. Long-term outcomes, including overall survival, freedom from reintervention, and freedom from aortic events, were evaluated using patient data recreated from digitized Kaplan-Meier curves. RESULTS: Thirty-seven studies with 4,178 patients were identified. The majority of the studies focused solely on acute dissections. Average follow-up was 3.2 years. Overall survival at 1-, 3-, and 5-year was 89.6%, 85.2%, and 82.0%, respectively. Freedom from reintervention at the same timepoints were 93.9%, 89.3%, and 86.8%, respectively. Mortality, permanent neurological deficit and spinal cord injury were 10.2%, 7.7%, and 6.5%, respectively. CONCLUSIONS: Survival after the FET procedure is favorable, though ongoing close serial monitoring is essential to assess for the need for further reintervention. Larger multi-institutional registries are required to provide more robust evidence to better elucidate the patient cohort that would most benefit from the FET. 2020 Annals of Cardiothoracic Surgery. All rights reserved.
BACKGROUND: The frozen elephant trunk (FET) procedure remains an increasingly popular approach to address complex multi-segmental aortic pathologies, owing to their ability to promote false lumen thrombosis and reduce the need for second-stage operations. While the short-term outcomes of such procedures have been shown to be acceptable, much less is known regarding long-term outcomes. This systematic review evaluates long-term outcomes of the FET procedure. METHODS: Studies with at least 12 months follow-up data on FETs were identified in four electronic databases. All studies were reviewed by two independent researchers and relevant data extracted. Long-term outcomes, including overall survival, freedom from reintervention, and freedom from aortic events, were evaluated using patient data recreated from digitized Kaplan-Meier curves. RESULTS: Thirty-seven studies with 4,178 patients were identified. The majority of the studies focused solely on acute dissections. Average follow-up was 3.2 years. Overall survival at 1-, 3-, and 5-year was 89.6%, 85.2%, and 82.0%, respectively. Freedom from reintervention at the same timepoints were 93.9%, 89.3%, and 86.8%, respectively. Mortality, permanent neurological deficit and spinal cord injury were 10.2%, 7.7%, and 6.5%, respectively. CONCLUSIONS: Survival after the FET procedure is favorable, though ongoing close serial monitoring is essential to assess for the need for further reintervention. Larger multi-institutional registries are required to provide more robust evidence to better elucidate the patient cohort that would most benefit from the FET. 2020 Annals of Cardiothoracic Surgery. All rights reserved.
Authors: Sergey Leontyev; Martin Misfeld; Piroze Daviewala; Michael A Borger; Christian D Etz; Sergey Belaev; Joerg Seeburger; David Holzhey; Farhard Bakhtiary; Friedrich W Mohr Journal: Ann Cardiothorac Surg Date: 2013-09
Authors: Paolo Berretta; Michele Galeazzi; Mariano Cefarelli; Jacopo Alfonsi; Veronica De Angelis; Michele Danilo Pierri; Sacha M L Matteucci; Eugenio Alessandroni; Carlo Zingaro; Filippo Capestro; Alessandro D'Alfonso; Marco Di Eusanio Journal: Indian J Thorac Cardiovasc Surg Date: 2021-12-06