Konstantinos Tsagakis1, Davide Pacini2, Martin Grabenwöger3, Michael A Borger4, Nora Goebel5, Wolfgang Hemmer6, Alvaro Laranjeira Santos7, Thanos Sioris8, Kazimierz Widenka9, Petar Risteski10, Jorge Mascaro11, Igor Rudez12, Andreas Zierer13, Carlos A Mestres14,15, Arjang Ruhparwar1, Roberto Di Bartolomeo2, Heinz Jakob1. 1. Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Essen, Germany. 2. Department of Cardiac Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy. 3. Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria. 4. Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany. 5. Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany. 6. Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany. 7. Department of Cardiothoracic Surgery, Hospital de Santa Marta, CHLC, Lisbon, Portugal. 8. Tampere University Hospital Heart Center, Tampere, Finland. 9. Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland. 10. Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany. 11. Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK. 12. Department of Cardiac and Transplant Surgery, University Hospital Dubrava, Zagreb, Croatia. 13. Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Kepler University Hospital Linz, Johannes Kepler University Linz, Linz, Austria. 14. Department of Cardio Vascular Surgery, Hospital Clinico, University of Barcelona, Barcelona, Spain. 15. Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland.
Abstract
BACKGROUND: Over the years, frozen elephant trunk (FET) has become the treatment of choice for multisegmental thoracic aortic disease. This multicenter study presents the evolution of FET results using the E-vita Open hybrid graft with respect to institutional experience and time. METHODS: The data of International E-vita Open registry were studied according to the institutional experience of the participating centers (high- versus low-volume centers) and according to the evolution of FET treatment during time (1st period, 2005-2011 versus 2nd period, 2012-2018). Overall, 1,165 patients were enrolled in the study with a wide variety of multisegmental thoracic aortic pathologies and aortic emergencies. Participating centers determined their own surgical protocol. RESULTS: The overall 30-day mortality was 12%. Short- and long-term survival were higher in high- versus low-volume centers (P=0.048 and P=0.013, respectively). In the 2nd time period, cerebral complications were reduced significantly (P=0.015). Incidence of permanent spinal cord-related symptoms was reduced to 3% in the 2nd time period, but did not reach statistical significance. Hypothermic circulatory arrest time (P<0.001) and incidence of postoperative temporary renal replacement therapy (P=0.008) were significantly reduced in the 2nd time period. Ten-year survival and freedom from aortic-related death rates were 46.6% and 85.7%, respectively, for the entire group. The freedom from distal aortic re-interventions for a new or progressive residual aortic disease was 76.0%. CONCLUSIONS: Evolution of FET arch repair techniques with the E-vita Open graft and increasing institutional experience were associated with improved results. Progression of residual aortic disease makes close follow-up with aortic imaging mandatory in such patients. 2020 Annals of Cardiothoracic Surgery. All rights reserved.
BACKGROUND: Over the years, frozen elephant trunk (FET) has become the treatment of choice for multisegmental thoracic aortic disease. This multicenter study presents the evolution of FET results using the E-vita Open hybrid graft with respect to institutional experience and time. METHODS: The data of International E-vita Open registry were studied according to the institutional experience of the participating centers (high- versus low-volume centers) and according to the evolution of FET treatment during time (1st period, 2005-2011 versus 2nd period, 2012-2018). Overall, 1,165 patients were enrolled in the study with a wide variety of multisegmental thoracic aortic pathologies and aortic emergencies. Participating centers determined their own surgical protocol. RESULTS: The overall 30-day mortality was 12%. Short- and long-term survival were higher in high- versus low-volume centers (P=0.048 and P=0.013, respectively). In the 2nd time period, cerebral complications were reduced significantly (P=0.015). Incidence of permanent spinal cord-related symptoms was reduced to 3% in the 2nd time period, but did not reach statistical significance. Hypothermic circulatory arrest time (P<0.001) and incidence of postoperative temporary renal replacement therapy (P=0.008) were significantly reduced in the 2nd time period. Ten-year survival and freedom from aortic-related death rates were 46.6% and 85.7%, respectively, for the entire group. The freedom from distal aortic re-interventions for a new or progressive residual aortic disease was 76.0%. CONCLUSIONS: Evolution of FET arch repair techniques with the E-vita Open graft and increasing institutional experience were associated with improved results. Progression of residual aortic disease makes close follow-up with aortic imaging mandatory in such patients. 2020 Annals of Cardiothoracic Surgery. All rights reserved.
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