Background and Objective: The frozen elephant trunk (FET) technique has undoubtable advantages in treating complex and extensive disease of the aortic arch and the thoracic descending aorta. Despite several improvements in cardiopulmonary bypass conduction and surgical strategy, operative times and the institution of systemic circulatory arrest remain the main determinants of early mortality, cerebral/spinal cord injury and visceral organs dysfunction. We have conducted this review to highlight the recent technical advances in arch and FET surgery aiming at the reduction/avoidance of systemic circulatory arrest, and their impact on early outcomes. Methods: A literature search (from origin to January 2022), limited to publications in English, was performed on online platforms and database (PubMed, Google, ResearchGate). After a further review of associated or similar papers, we found 4 experiences, described by 11 peer-reviewed published papers, which focused on minimising or avoiding systemic circulatory arrest during total arch replacement plus stenting of the descending thoracic aorta. Key Content and Findings: Recent experiences reported the use of an antegrade endoaortic balloon, advanced and inflated into the stent graft, to provide an early systemic reperfusion soon after the deployment of the stented portion of the FET prosthesis and minimize the circulatory arrest time (down to a mean of 5 minutes), thus avoiding the need of moderate or deep hypothermia (mean systemic temperature 28-30 °C) while allowing a complete arch and FET repair. Our approach, based on off-pump retrograde vascular stent graft deployment in distal arch/descending thoracic aorta, and the use of a retrograde endoballoon, allows the repair of extensive aortic pathologies during uninterrupted normothermic cerebral and lower body perfusion. Conclusions: The use of endoballoon occlusion has emerged in recent years as a safe and effective strategy to allow distal perfusion during FET repair. This technique minimizes or avoids the detrimental effects of hypothermia and systemic circulatory arrest and significantly reduces the operative times. 2022 Cardiovascular Diagnosis and Therapy. All rights reserved.
Background and Objective: The frozen elephant trunk (FET) technique has undoubtable advantages in treating complex and extensive disease of the aortic arch and the thoracic descending aorta. Despite several improvements in cardiopulmonary bypass conduction and surgical strategy, operative times and the institution of systemic circulatory arrest remain the main determinants of early mortality, cerebral/spinal cord injury and visceral organs dysfunction. We have conducted this review to highlight the recent technical advances in arch and FET surgery aiming at the reduction/avoidance of systemic circulatory arrest, and their impact on early outcomes. Methods: A literature search (from origin to January 2022), limited to publications in English, was performed on online platforms and database (PubMed, Google, ResearchGate). After a further review of associated or similar papers, we found 4 experiences, described by 11 peer-reviewed published papers, which focused on minimising or avoiding systemic circulatory arrest during total arch replacement plus stenting of the descending thoracic aorta. Key Content and Findings: Recent experiences reported the use of an antegrade endoaortic balloon, advanced and inflated into the stent graft, to provide an early systemic reperfusion soon after the deployment of the stented portion of the FET prosthesis and minimize the circulatory arrest time (down to a mean of 5 minutes), thus avoiding the need of moderate or deep hypothermia (mean systemic temperature 28-30 °C) while allowing a complete arch and FET repair. Our approach, based on off-pump retrograde vascular stent graft deployment in distal arch/descending thoracic aorta, and the use of a retrograde endoballoon, allows the repair of extensive aortic pathologies during uninterrupted normothermic cerebral and lower body perfusion. Conclusions: The use of endoballoon occlusion has emerged in recent years as a safe and effective strategy to allow distal perfusion during FET repair. This technique minimizes or avoids the detrimental effects of hypothermia and systemic circulatory arrest and significantly reduces the operative times. 2022 Cardiovascular Diagnosis and Therapy. All rights reserved.
Authors: Marco Di Eusanio; Sebastiano Castrovinci; David H Tian; Gianluca Folesani; Mariano Cefarelli; Antonio Pantaleo; Giacomo Murana; Paolo Berretta; Tristan D Yan; Roberto Di Bartolomeo Journal: Eur J Cardiothorac Surg Date: 2013-10-24 Impact factor: 4.191
Authors: Christian D Etz; Maximilian Luehr; Fabian A Kari; Hung Mo Lin; George Kleinman; Stefano Zoli; Konstadinos A Plestis; Randall B Griepp Journal: Eur J Cardiothorac Surg Date: 2009-07-28 Impact factor: 4.191
Authors: Malakh Shrestha; Tim Kaufeld; Erik Beckmann; Felix Fleissner; Julia Umminger; Firas Abd Alhadi; Dietmar Boethig; Heike Krueger; Axel Haverich; Andreas Martens Journal: J Thorac Cardiovasc Surg Date: 2016-04-09 Impact factor: 5.209
Authors: Malakh Shrestha; Jean Bachet; Joseph Bavaria; Thierry P Carrel; Ruggero De Paulis; Roberto Di Bartolomeo; Christian D Etz; Martin Grabenwöger; Michael Grimm; Axel Haverich; Heinz Jakob; Andreas Martens; Carlos A Mestres; Davide Pacini; Tim Resch; Marc Schepens; Paul P Urbanski; Martin Czerny Journal: Eur J Cardiothorac Surg Date: 2015-03-13 Impact factor: 4.191