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Geragotellis A, Jubouri M, Al-Tawil M, Mohammed I, Bashir M, Hosseini S. The Fate of Conventional Elephant Trunk in the Frozen Elephant Trunk Era. AORTA (STAMFORD, CONN.) 2024. [PMID: 38754437 DOI: 10.1055/s-0044-1786352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Conventional elephant trunk (cET) and frozen elephant trunk (FET) are two distinct approaches to the surgical treatment of thoracic aortic aneurysms and dissections. With the advent and growing uptake of endovascular technologies, FET is becoming increasingly popular for its potential to be performed as a single-stage operation with better aortic remodeling and less risk of graft kinking than the traditional two-stage cET procedure. However, FET has been associated with a higher risk of spinal cord ischemia and its use in patients with connective tissue disorder remains controversial. The current review aimed to reflect on recent evidence surrounding the application of cET and FET to different types of aortic pathology in both acute and elective settings. Another scope of this review was to compare the characteristics of the currently available FET commercial devices on the global market. Our findings highlight that when the pathology is confined to the proximal descending aorta, such as in Dsine, intervention is often single-staged and false lumen (FL) thrombosis is achieved with good effect. FET remains limited by spinal cord injury and applicability in patients with connective tissue disorder, although some groups have started to circumvent associated complications, likely due to growing surgical expertise. Many other aortic diseases do require second-stage intervention, and even in these cases, there appears to be lower in-hospital mortality when using FET over cET. This is possibly due to the higher rate of endovascular completion facilitated by the completed landing zones created during FET. FET is trending toward becoming the universal treatment modality for extending repair to the descending aorta.
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Affiliation(s)
| | | | | | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Mohamad Bashir
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
- Department of Vascular & Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales (HEIW), Cardiff, United Kingdom
- Heart Valve Disease Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Heart Valve Disease Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
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Shadanov AA, Sirota DA, Liashenko MM, Khvan DS, Cherniavskiĭ AM. [Hybrid grafts for aortic arch reconstruction: evolution and state of the art]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:41-49. [PMID: 34166343 DOI: 10.33529/angio2021126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The analysis of the gained experience in treatment of patients with pathology of the arch and descending portion of the aorta is suggestive that the 'frozen elephant trunk' technique is an effective and safe method. In this connection, there is an increasing need for universal hybrid devices characterized by ease of use and durability in various aortic pathologies. Discussed in the article is the state of the art of the technology of treatment of patient with aortic arch pathology by means of hybrid grafts, followed by comparative analysis of currently used vascular hybrid prostheses, and although none of the hybrid grafts available worldwide is either universal or ideal, the grafts for the 'frozen elephant trunk' procedure continue to be improved, which will inevitably lead to wide implementation of this technique.
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Affiliation(s)
- A A Shadanov
- Cardiosurgical Department of the Aorta and Coronary Arteries, E.N. Meshalkin National Medical Research Centre under the RF Ministry of Public Health, Novosibirsk, Russia
| | - D A Sirota
- Cardiosurgical Department of the Aorta and Coronary Arteries, E.N. Meshalkin National Medical Research Centre under the RF Ministry of Public Health, Novosibirsk, Russia
| | - M M Liashenko
- Cardiosurgical Department of the Aorta and Coronary Arteries, E.N. Meshalkin National Medical Research Centre under the RF Ministry of Public Health, Novosibirsk, Russia
| | - D S Khvan
- Cardiosurgical Department of the Aorta and Coronary Arteries, E.N. Meshalkin National Medical Research Centre under the RF Ministry of Public Health, Novosibirsk, Russia
| | - A M Cherniavskiĭ
- Cardiosurgical Department of the Aorta and Coronary Arteries, E.N. Meshalkin National Medical Research Centre under the RF Ministry of Public Health, Novosibirsk, Russia
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Schepens M, Ranschaert W, Vergauwen W, Graulus E, De Vos M. Is the classical elephant trunk better than the frozen elephant trunk? Indian J Thorac Cardiovasc Surg 2021; 38:64-69. [PMID: 35463703 PMCID: PMC8980961 DOI: 10.1007/s12055-020-01131-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 01/08/2023] Open
Abstract
Aortic diseases located in the ascending aorta, aortic arch or proximal descending aorta often require more than one surgical intervention depending on the type of pathology and its extent as well as future anticipated aortic problems. These obstacles were tackled in 1983 by Hans Borst with the introduction of the classic elephant trunk (cET). This was an outstanding and straightforward procedure. Since then, the cET was very often the first surgical approach for patients with extensive aortic pathology of the ascending aorta and arch extending into the downstream aorta. Thirteen years later, Suto and Kato introduced the frozen elephant trunk (fET) which was later on perfectionized by industry and applied in various ways by many surgical groups worldwide. Comparing the cET with the fET raises a lot of difficulties. The lack of randomization and the presence of procedural and complication-related limitations for each technique do not allow for definitive conclusions about the ideal procedure to treat complex aortic pathology. It would be very short-sighted to close all future discussions about the subject with this statement of the Hannover group made in 2011. Since both techniques and its results cannot be compared statistically due to the heterogeneity of patient groups, the lack of randomization, the difference in type and extent of pathology, the differences in surgical techniques, the learning curve in gaining experience in both techniques, and the lack of reporting standards, no scientific conclusion can be drawn as to which technique is most successful. Comparisons may even be considered futile. It is the purpose of this paper merely to make a descriptive observation of both techniques, to discuss some important elements of interest and to give some constructive and useful criticism.
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Affiliation(s)
- Marc Schepens
- Department of Cardiac Surgery, AZ St.Jan, Ruddershove 10, 8000 Brugge, Belgium
| | - Willem Ranschaert
- Department of Cardiac Surgery, AZ St.Jan, Ruddershove 10, 8000 Brugge, Belgium
| | - Wim Vergauwen
- Department of Cardiac Surgery, AZ St.Jan, Ruddershove 10, 8000 Brugge, Belgium
| | - Eric Graulus
- Department of Cardiac Surgery, AZ St.Jan, Ruddershove 10, 8000 Brugge, Belgium
| | - Marie De Vos
- Department of Cardiac Surgery, AZ St.Jan, Ruddershove 10, 8000 Brugge, Belgium
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Preventza O, Coselli JS, Mayor J, Simpson K, Carillo J, Price MD, Cornwell LD, Omer S, de la Cruz KI, Bakaeen FG, Jobe A. The Stent Is Not to Blame: Lessons Learned With a Simplified US Version of the Frozen Elephant Trunk. Ann Thorac Surg 2017. [DOI: 10.1016/j.athoracsur.2017.03.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kirali K, Ardal H, Erentuğ V, Mansuroğlu D, Bozbuğa NU, Yakut C. Surgical Outcome of Subtypes of Aortic Arch Dissection. Asian Cardiovasc Thorac Ann 2016; 12:300-5. [PMID: 15585697 DOI: 10.1177/021849230401200405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was conducted to investigate if the site of primary intimal tear involving the aortic arch and the surgical approach affect the early and late results of total aortic arch replacement. Between 1993 and November 2001, 42 patients underwent graft replacement of the total aortic arch for aortic dissection. Their mean age was 51.9 ± 9.8 years, and 38 of them were male. All operations were performed under hypothermic circulatory arrest with retrograde cerebral perfusion. Hospital mortality was 28.6% (12 patients). There were 2 late deaths. Multivariate analysis showed that chronic obstructive pulmonary disease and ascending aortic replacement with or without valve replacement were significant independent determinants of early death. Patients with the intimal tear originating in the ascending aorta showed a tendency towards lower 7-year survival rates than those with a tear at other aortic sites or with multiple tears, while the presence of chronic obstructive pulmonary disease adversely affected early and late outcomes. We conclude that the primary site of an intimal tear that involves the aortic arch affects early and late survival, but concomitant non-cardiac diseases play an even more important role in the early outcome as they increase the complexity of the operation.
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Affiliation(s)
- Kaan Kirali
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Kadiköy, Istanbul 81020, Turkey.
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Preventza O, Coselli JS. It Is Difficult to Compare Apples to Oranges: Acute and Chronic Type B Aortic Dissections, Complicated and Uncomplicated, Are Different and Should Be Treated as Such. Semin Thorac Cardiovasc Surg 2015; 27:113-4. [PMID: 26686434 DOI: 10.1053/j.semtcvs.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
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A complex procedure in the thoracic endovascular aortic repair era needs long-term follow-up to compete. J Thorac Cardiovasc Surg 2015; 150:1166-7. [PMID: 26365399 DOI: 10.1016/j.jtcvs.2015.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 11/23/2022]
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Ma WG, Zheng J, Sun LZ, Elefteriades JA. Open Stented Grafts for Frozen Elephant Trunk Technique: Technical Aspects and Current Outcomes. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:122-35. [PMID: 27069943 DOI: 10.12945/j.aorta.2015.14.062] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/06/2015] [Indexed: 12/19/2022]
Abstract
With growing experience in patients with aneurysms and dissections in the arch and proximal descending aorta, the frozen elephant trunk (FET) technique has been shown to be safe and effective, and has achieved favorable short to mid-term outcomes. As the FET technique is gaining wider acceptance, there is a growing need for versatile, technically simple, and highly durable open stented grafts involving less complicated deployment mechanisms enabling use in various indications. This paper gives a brief review on the technical aspects and clinical outcomes of currently available open stented grafts used in the FET technique, including the E-vita Open Plus, Thoraflex Hybrid, Cronus, and J Graft. While none of these grafts can claim to be an ideal device, technology continues to improve towards this goal. As newer devices and systems are developed, more widespread use of the FET technique can be expected; such progress promises to improve the clinical outcomes and quality of life for patients with complex aortic diseases.
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Affiliation(s)
- Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jun Zheng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
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Shrestha M, Bachet J, Bavaria J, Carrel TP, De Paulis R, Di Bartolomeo R, Etz CD, Grabenwöger M, Grimm M, Haverich A, Jakob H, Martens A, Mestres CA, Pacini D, Resch T, Schepens M, Urbanski PP, Czerny M. Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS. Eur J Cardiothorac Surg 2015; 47:759-69. [DOI: 10.1093/ejcts/ezv085] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 02/02/2015] [Indexed: 01/05/2023] Open
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Duarte JJ, Pontes JCDV, Benfatti RA, Ferrachini AL, Karakhanian WK, Razuk Filho A. Indication of endovascular treatment of type B aortic dissection--literature review. Braz J Cardiovasc Surg 2014; 29:396-401. [PMID: 25372915 PMCID: PMC4412331 DOI: 10.5935/1678-9741.20140076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/26/2014] [Indexed: 11/20/2022] Open
Abstract
Aortic dissection is a cardiovascular event of high mortality if not early diagnosed
and properly treated. In Stanford type A aortic dissection, there is the involvement
of the ascending aorta, whereas in type B the ascending aorta is not affected. The
treatment of type A aortic dissection is mainly surgical. The hospital mortality of
type B aortic dissection surgical treatment is approximately 20%, while medical
therapy is 10%. However, half the patients who are discharged from hospital after
medical treatment, progress to aortic complications in the following years, and the
mortality in three to five years may reach 25-50%. In addition, the surgical
treatment of aortic complications after medical treatment, has also a significant
mortality. This way, the endovascular treatment comes up as an interesting
alternative of a less invasive treatment for this disease. They presented a mortality
rate lower than 10% with more than 80% success rate of occlusion and thrombosis of
the false lumen. The INSTEAD TRIAL, which randomized patients with uncomplicated type
B aortic dissection for optimal medical therapy and endovascular treatment in
addition to optimal medical therapy, showed that after three years of follow up,
patients who underwent endovascular treatment had lower mortality and aorta-related
complications. Therefore, there is a current tendency to recommend the endovascular
treatment as a standard for the treatment of type B aortic dissection
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Affiliation(s)
| | | | | | | | | | - Alvaro Razuk Filho
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
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Wan Ab Naim WN, Ganesan PB, Sun Z, Chee KH, Hashim SA, Lim E. A perspective review on numerical simulations of hemodynamics in aortic dissection. ScientificWorldJournal 2014; 2014:652520. [PMID: 24672348 PMCID: PMC3932246 DOI: 10.1155/2014/652520] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/05/2013] [Indexed: 11/30/2022] Open
Abstract
Aortic dissection, characterized by separation of the layers of the aortic wall, poses a significant challenge for clinicians. While type A aortic dissection patients are normally managed using surgical treatment, optimal treatment strategy for type B aortic dissection remains controversial and requires further evaluation. Although aortic diameter measured by CT angiography has been clinically used as a guideline to predict dilation in aortic dissection, hemodynamic parameters (e.g., pressure and wall shear stress), geometrical factors, and composition of the aorta wall are known to substantially affect disease progression. Due to the limitations of cardiac imaging modalities, numerical simulations have been widely used for the prediction of disease progression and therapeutic outcomes, by providing detailed insights into the hemodynamics. This paper presents a comprehensive review of the existing numerical models developed to investigate reasons behind tear initiation and progression, as well as the effectiveness of various treatment strategies, particularly the stent graft treatment.
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Affiliation(s)
- Wan Naimah Wan Ab Naim
- Department of Biomedical Engineering, Faculty of Engineering Building, University of Malaya, 50603 Kuala Lumpur, KL, Malaysia
| | - Poo Balan Ganesan
- Department of Mechanical Engineering, Faculty of Engineering Building, University of Malaya, 50603 Kuala Lumpur, KL, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, WA 6845, Australia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine Building, University of Malaya, 50603 Kuala Lumpur, KL, Malaysia
| | - Shahrul Amry Hashim
- Department of Surgery, Faculty of Medicine Building, University of Malaya, 50603 Kuala Lumpur, KL, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering Building, University of Malaya, 50603 Kuala Lumpur, KL, Malaysia
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Abstract
TEVAR is a new strategy for treating both acute and chronic type B aortic dissection. The JSC guidelines classify TEVAR as a Class I recommendation for cases of complicated acute type B dissection and a Class IIa recommendation for cases of chronic type B aortic dissection. While TEVAR has been primarily applied to treat complicated acute type B aortic dissection in Europe and the USA, the procedure remains an off-label treatment strategy for aortic dissection in Japan. The current state of TEVAR for type B aortic dissection in Japan from 2001 to 2011 is estimated in the annual reports of the Japanese Association for Thoracic Surgery. The number of acute type B aortic dissection patients treated with transluminal stent grafting increased rapidly after 2008, from 10 cases in 2001 to 76 cases in 2010. Meanwhile, the number acute type B aortic dissection patients treated with any type of surgery has increased gradually, from 100 cases in 2001 to 194 cases in 2009. The number of chronic type B aortic dissection patients treated with transluminal stent grafting increased abruptly in 2010, reaching 346 cases, which accounted for one-third of all surgical procedures for chronic type B aortic dissection. Furthermore, the number of open surgeries for chronic type B aortic dissection has also increased gradually, from 401 cases in 2001 to 947 cases in 2011. At present, open surgery, TEVAR and hybrid procedures are available to treat patients with type B aortic dissection. The use of a multidisciplinary team approach is mandatory when selecting the appropriate surgical strategy.
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Leontyev S, Misfeld M, Daviewala P, Borger MA, Etz CD, Belaev S, Seeburger J, Holzhey D, Bakhtiary F, Mohr FW. Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques-a single center study. Ann Cardiothorac Surg 2013; 2:606-11. [PMID: 24109568 DOI: 10.3978/j.issn.2225-319x.2013.09.22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/26/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND The treatment of patients with extensive thoracic aortic disease involving the arch and descending thoracic/thoracoabdominal aorta is often performed using the frozen elephant trunk technique (FET). We retrospectively analyzed our results of the FET operation. METHODS A total of 51 consecutive patients underwent total aortic arch surgery with the FET technique between January 2006 and August 2013. For all patients, the E-vita hybrid open stent-graft (Jotec, Hechingen, Germany) was used. The patients had a mean age of 64±13 years, with 51.1% being female. Degenerative or atherosclerotic aneurysm was the indication for surgery in 62.7% of patients. Another 15.7% and 13.7% suffered from acute Type A, and Type B aortic dissection, respectively. RESULTS The in-hospital and 30-day mortality was 7.8%. Stroke occurred in 11.8% (n=6), and new-onset paraplegia in 19.6% (n=10) of patients. The core body temperature ≥28 °C during circulatory arrest, in combination with a prolonged circulatory arrest time of more than 45 minutes, was an independent predictor of permanent spinal cord injury [odds ratios (OR), 4.8; 95% confidence intervals (CI), 1.1-21; P=0.04]. The estimated 1- and 5-year survival was (80.2±5.5)% and (59.7±10.2)%, respectively, with a mean survival time of 3.4±0.4 years. The estimated mean freedom from endovascular intervention was 4.2±0.4 years. The unadjusted 1- and 5-year freedom from thoracic endovascular aortic repair (TEVAR) was (84.9±5.9)% and (69.2±11.2)%, respectively. CONCLUSIONS The FET procedure for extensive thoracic aortic disease is associated with an acceptable early and medium term mortality rate. This procedure is associated with a high incidence of perioperative spinal cord injury. In order to prevent the above complication, deep hypothermia is strongly recommended in patients with expected prolonged circulatory arrest time.
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Affiliation(s)
- Sergey Leontyev
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
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Leontyev S, Borger MA, Etz CD, Moz M, Seeburger J, Bakhtiary F, Misfeld M, Mohr FW. Experience with the conventional and frozen elephant trunk techniques: a single-centre study. Eur J Cardiothorac Surg 2013; 44:1076-82; discussion 1083. [DOI: 10.1093/ejcts/ezt252] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ye C, Chang G, Li S, Hu Z, Yao C, Chen W, Li X, Wang S. Endovascular stent-graft treatment for Stanford type A aortic dissection. Eur J Vasc Endovasc Surg 2011; 42:787-94. [PMID: 21903426 DOI: 10.1016/j.ejvs.2011.08.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 08/15/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of the study is to summarise our experience of endovascular stent grafting for Stanford type A aortic dissection. DESIGN Retrospective analysis at single centre. METHODS From January 2001 to January 2009, we treated 45 cases of Stanford type A aortic dissection with endovascular stent grafting. The entry tear was located at the ascending aorta in 10 cases (DeBakey type I), the aortic arch in 14 cases and the distal aortic arch or proximal descending aorta in 21 cases in which the ascending aorta was also involved by the dissection. RESULTS The surgical success rate was 97.8% (44/45) and 30-day mortality rate was 6.7% (3/45). Type I endoleaks occurred in 10 cases: one patient died intra-operatively, four were successfully treated with ballooning, four were sealed with aortic cuffs and one case caused by left subclavian artery (LSA) reflux was sealed with an occluder. Average follow-up time was 35.5 ± 5.4 months. Up to the most recent review or death, 32 patients had complete thrombosis and 10 had partial thrombosis inside the false lumen. Two deaths occurred after 30-days postoperatively. CONCLUSION Endovascular stent-graft treatment is a minimally invasive and effective method to treat Stanford type A aortic dissection.
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Affiliation(s)
- C Ye
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
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16
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Elephant trunk procedure 27 years after Borst: what remains and what is new? Eur J Cardiothorac Surg 2011; 40:1-11. [PMID: 21388822 DOI: 10.1016/j.ejcts.2011.01.062] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/24/2011] [Accepted: 01/27/2011] [Indexed: 11/21/2022] Open
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Uchida N, Katayama A, Tamura K, Sutoh M, Murao N, Kuraoka M. Early entry closure for acute type B aortic dissection by open stent grafting. Gen Thorac Cardiovasc Surg 2011; 59:329-34. [PMID: 21547626 DOI: 10.1007/s11748-010-0749-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 11/24/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE We describe the long-term efficacy of early entry closure for acute type B aortic dissection by open stent grafting based on long-term results and changes in the false lumen on enhanced computed tomography (CT). METHODS We performed open stent grafting for acute type B aortic dissection in 28 28 patients between 1998 a 2008. They included 14 patients with complicated type B aortic dissection (11 patients with limb and/or visceral ischemia and 4 patients with impending rupture). Uncomplicated type B aortic dissection was present in 14 patients, including 4 patients with an ulcer-like projection and 10 patients who had stable dissection with a patent false lumen. RESULTS Two patients who had the ischemic type died within 30 days. Postoperative complications occurred in two patients, including one case of paraplegia and one of mediastinitis. Two more deaths occurred during a median follow-up period of 45 months (range 6-114 months), with one related to open stent-graft infection and one due to pneumonia. The overall survival rate 5 years after open stent grafting was 77%. According to follow-up by CT, the false lumen was completely thrombosed and obliterated in all 26 patients with stent grafts. CONCLUSION Early entry closure for both complicated and uncomplicated acute type B aortic dissection with an open stent graft has an acceptable early outcome and provides a high aortic remodeling rate.
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Affiliation(s)
- Naomichi Uchida
- Division of Cardiovascular Surgery, Hiroshima Asa General Hospital, 2-1-1 Kabe-minami, Asa-kita-ku, Hiroshima 731-0293, Japan.
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Mohammadi Tofigh A, Ghasemi M, Aghdam BH, Karvandi M, Kaboli A. Endovascular treatment of thoracoabdominal aortic aneurysm: a case report. J Med Case Rep 2010; 4:37. [PMID: 20205854 PMCID: PMC2825520 DOI: 10.1186/1752-1947-4-37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 02/02/2010] [Indexed: 12/04/2022] Open
Abstract
Introduction Thoracoabdominal aortic aneurysms usually present in elderly patients with serious renal, pulmonary, cerebral, or cardiac comorbidities that pose a great challenge to the attending surgeon. Endovascular techniques for the treatment of thoracoabdominal aneurysms are not yet widely used due to limitations associated with them, such as spinal and visceral ischemia. Case presentation An 87-year-old Caucasian man with a symptomatic Crawford type I thoracoabdominal aortic aneurysm was treated successfully with a long tube stent graft using endovascular techniques and without any complication in follow-up examinations. The stent was placed distal to the left subclavian artery, and proximal to the celiac axis. Conclusion The use of endovascular stents for long segment thoracoabdominal aortic aneurysms needs to undergo clinical investigation to determine whether this procedure decreases morbidity and mortality rates.
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Bhamidipati CM, Ailawadi G. Acute complicated and uncomplicated type III aortic dissection: an endovascular perspective. Semin Thorac Cardiovasc Surg 2010; 21:373-86. [PMID: 20226352 DOI: 10.1053/j.semtcvs.2009.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2009] [Indexed: 11/11/2022]
Abstract
Type III aortic dissection is associated with high morbidity and mortality. There is a shifting paradigm in the treatment of complicated and uncomplicated acute type III aortic dissection toward earlier endovascular repair. In this review, the authors present the current perspective on the endovascular management of acute complicated and uncomplicated type III aortic dissection.
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Affiliation(s)
- Castigliano M Bhamidipati
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Parsa CJ, Schroder JN, Daneshmand MA, McCann RL, Hughes GC. Midterm Results for Endovascular Repair of Complicated Acute and Chronic Type B Aortic Dissection. Ann Thorac Surg 2010; 89:97-102; discussion 102-4. [PMID: 20103214 DOI: 10.1016/j.athoracsur.2009.09.029] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 09/12/2009] [Accepted: 09/15/2009] [Indexed: 11/27/2022]
Affiliation(s)
- Cyrus J Parsa
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Schoder M, Czerny M, Cejna M, Rand T, Stadler A, Sodeck GH, Gottardi R, Loewe C, Lammer J. Endovascular Repair of Acute Type B Aortic Dissection: Long-Term Follow-Up of True and False Lumen Diameter Changes. Ann Thorac Surg 2007; 83:1059-66. [PMID: 17307460 DOI: 10.1016/j.athoracsur.2006.10.064] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Revised: 10/21/2006] [Accepted: 10/24/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to determine the technical success after endovascular treatment of acute type B aortic dissections and to evaluate true and false lumen diameter changes at long-term follow-up. METHODS Twenty-eight patients with acute type B-dissection who were treated by stent graft repair presented with rupture (n = 1), contained rupture (n = 2), compromised branch vessels (n = 14), pleural effusion (n = 11), rapid aortic diameter progression (n = 5), persistent pain (n = 3), refractory hypertension (n = 10), and an aortic diameter of more than 4 cm (n = 4). Taking into account the perfusion status of the false lumen, diameter changes were monitored in the thoracic aorta at the level of the stented segment (L1), distal to the stent graft (L2), and at the level of the celiac trunk (L3). RESULTS Severe complications in 9 patients (32%) resulted in 3 deaths for a 30-day mortality rate of 10.7%. Primary sealing of the entry tear was achieved in 86%. At all levels, the true lumen diameter increased significantly after stent graft placement. At the 1-year follow-up, the false lumen in L1 was thrombosed in 90% and the mean difference of diameter reduction was highly significant. In L2, complete false lumen thrombosis occurred in 60% with a significant diameter decrease. In L3, the false lumen thrombosed in only 22%, and the mean difference of false lumen diameter increase reached significance at the 2-year follow-up. CONCLUSIONS Ninety percent of patients were treated successfully with thrombosis of the false lumen in the stented segment. False lumen perfusion distal to the stent graft resulted in diameter increase in several patients leaving these segments an area of concern.
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Affiliation(s)
- Maria Schoder
- Department of Angiography and Interventional Radiology, Medical University of Vienna, Vienna, Austria.
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22
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Pocar M, Fundarò P, Donatelli F. Simplified thoracic aortic aneurysm repair. Ann Thorac Surg 2004; 77:2199-200. [PMID: 15172303 DOI: 10.1016/s0003-4975(03)01252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2003] [Indexed: 11/27/2022]
Abstract
Descending thoracic and thoracoabdominal aortic operations still represent a challenge for the cardiovascular surgeon. In recent years, endovascular stent grafting has become a popular alternative to a conventional operation in selected patients, but is not always readily available or is technically contraindicated; also, long-term results are unknown. We describe a simplified surgical technique to secure a standard vascular prosthesis by performing a modified "elephant trunk" operation and discuss potential indications for its application.
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Affiliation(s)
- Marco Pocar
- Cattedra e Divisione di Cardiochirurgia, Università degli Studi di Milano e IRCCS Ospedale Maggiore, Milan, Italy.
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23
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Karck M, Chavan A, Hagl C, Friedrich H, Galanski M, Haverich A. The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms. J Thorac Cardiovasc Surg 2003; 125:1550-3. [PMID: 12830086 DOI: 10.1016/s0022-5223(03)00045-x] [Citation(s) in RCA: 212] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Matthias Karck
- Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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Mizuno T, Toyama M, Tabuchi N, Sunamori M. Transaortic stented graft implantation for aortic arch aneurysm. Its benefits and risk. Gen Thorac Cardiovasc Surg 2003; 51:53-8. [PMID: 12692932 DOI: 10.1007/bf02719167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite steady improvements, surgery for aortic arch disease, including the distal arch, continues to result in high rates of morbidity and mortality. We have performed aortic arch repair using a transaortic stented graft implantation into the descending aorta in 8 patients who had true aortic arch aneurysms, and here have reviewed the efficacy and problems from this procedure. METHODS Six patients underwent transaortic stented graft implantation into the descending aorta with bypass to the arch vessels. The other two underwent stented graft implantation into the descending aorta with replacement of the ascending aorta and aortic arch. One patient had a ruptured aneurysm. RESULTS Each operation was performed via a median sternotomy without left thoracotomy. There was no new postoperative occurrence of left recurrent laryngeal nerve palsy. All the five patients without perioperative neurological complication could be extubated within 24 h after surgery. In each case, postoperative enhanced computed tomography scans showed successful thromboexclusion of the aneurysm. There was no endoleak and no graft migration. One patient suffered cerebral injury. Spinal cord injury occurred in 2 patients, and this serious complication may have been caused by prolonged ischemia in the lower body and the long stented graft. CONCLUSIONS This surgical strategy was effective for arch aneurysm and produced less damage than a conventional procedure to the postoperative respiratory function, while the operative technique need to be improved to decrease the frequency of brain and spinal cord injury.
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Affiliation(s)
- Tomohiro Mizuno
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Machii M, Ohara K, Imai H, Lin ZB, Sudo K, Yoshimura H. Open surgical intervention to recurrent aortic dissection after endovascular stent grafting. Ann Thorac Surg 2002; 74:2186-9. [PMID: 12643422 DOI: 10.1016/s0003-4975(02)04107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the case of a 49-year-old man who received open-heart surgery for recurrent aortic dissection after endovascular stent grafting. Stent grafting had been successfully performed in the acute phase. Recurrent dissection became obvious 5 months later, and at the same time, aneurysmal change was detected between the left subclavian artery and the proximal end of the stent graft. We employed a "Y arch" surgical procedure and "elephant trunk" technique to treat, and the entry tear was completely sealed and the aneurysm was excluded by elephant trunk segment. We believe that this approach could be a new option for treatment for complicated aortic aneurysms.
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Affiliation(s)
- Masato Machii
- Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
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Pocar M, Donatelli F. Median sternotomy for combined cardiac and descending thoracic aortic operation. Ann Thorac Surg 2002; 74:2226-7; author reply 2227. [PMID: 12643437 DOI: 10.1016/s0003-4975(02)04047-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Palma JH, Miranda F, Gasques AR, Alves CMR, de Souza JAM, Buffolo E. Treatment of thoracoabdominal aneurysm with self-expandable aortic stent grafts. Ann Thorac Surg 2002; 74:1685-7. [PMID: 12440631 DOI: 10.1016/s0003-4975(02)04028-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A 67-year-old man with a large thoracoabdominal aneurysm was treated utilizing the endovascular approach with multiple stent graft implantation. The proximal thoracic and distal abdominal necks of the aneurysm had favorable anatomy for insertion of multiple endovascular stents. The proximal end was located just distal to the left subclavian artery, and stents were placed to the region of the celiac axis. The infrarenal aneurysm was treated with a bifurcated stent graft to the iliac arteries. The patient has had a smooth post-stent insertion course and remains well after 3 months of follow-up.
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Affiliation(s)
- José Honório Palma
- Department of Cardiovascular Surgery, Medical School, São Paulo Federal University, São Paulo, Brazil.
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Buffolo E, da Fonseca JHP, de Souza JAM, Alves CMR. Revolutionary treatment of aneurysms and dissections of descending aorta: the endovascular approach. Ann Thorac Surg 2002; 74:S1815-7; discussion S1825-32. [PMID: 12440672 DOI: 10.1016/s0003-4975(02)04138-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute aortic dissection is a life-threatening medical condition. It is associated with high morbidity and mortality. Type B dissections are usually managed clinically during the acute phase. Conventional surgery carries high mortality rates due to the presence of serious complications. We herein present treatment of this condition with a less invasive endovascular approach. Other clinical situations such as penetrating ulcers, intramural hematomas, and true aneurysms of descending aorta were similarly treated. METHODS From December 1996 to March 2002, 191 patients with type B dissections were treated with self-expandable, polyester-covered stents. There were 120 patients (62.8%) with type B dissections, 61 patients (31.9%) with true aneurysms, 6 patients (3.1%) with penetrating ulcers or intramural hematomas, and 4 patients (2.1%) with trauma. Patients with abdominal aneurysms (44) and stents introduced under direct vision through the aortic arch (70) were excluded. The stent graft was delivered in the catheterization laboratory under general anesthesia, with induced hypotension and heparinization. All stents used were made in Brazil (Braile Biomedics, Sao Jose do Rio Preto, SP). RESULTS The procedure was performed in 191 consecutive cases. The success rate was 91.1% (174/191). Success was defined as occlusion of the thoracic intimal tear, or exclusion of the aneurysm without leaks. Hospital mortality was 10.4% (20/191 patients), due to preoperative comorbidities. Six patients required conversion to surgery. No case of paraplegia was observed. An actuarial survival curve showed 87.4% +/- 29% survival in the late follow-up period. CONCLUSIONS Stent grafts are an important development in the treatment of descending aortic aneurysms or dissections. This novel approach may replace conventional surgical treatment of these conditions, with earlier intervention and less morbidity.
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Affiliation(s)
- Enio Buffolo
- Federal University of São Paulo, Paulista School of Medicine and Affiliated Hospitals, SP, Brazil.
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Palma JH, de Souza JAM, Rodrigues Alves CM, Carvalho AC, Buffolo E. Self-expandable aortic stent-grafts for treatment of descending aortic dissections. Ann Thorac Surg 2002; 73:1138-41; discussion 1141-2. [PMID: 11996254 DOI: 10.1016/s0003-4975(02)03397-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute aortic dissection is a life-threatening medical condition that is associated with high morbidity and mortality. METHODS Of 198 patients treated with a self-expanding polyester-covered stent-graft for various pathologic aortic conditions in our institution, we selected 70 consecutive patients with type B aortic dissection who were undergoing treatment. The stent-graft was introduced through the femoral artery in the angiography suite, under general anesthesia with systemic heparinization and induced hypotension. RESULTS The procedure was performed in 70 patients; of these, 58 had descending aortic dissection and 12 had atypical dissections. The procedure was successful in 65 patients (92.9%), as documented by exclusion of the false lumen of the thoracic aorta. Eleven patients (18.9%) had persistent blood flow in the false lumen of the abdominal aorta due to distal reentries. Five patients (7.1%) underwent conversion to surgery. Insertion of additional stent-grafts was required in 34 patients (48.6%). At 29 months of follow-up, 91.4% of the patients were alive. CONCLUSIONS Stent-grafts are an important means of treating aortic dissections, which may replace conventional medical treatment of this condition for the majority of patients.
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Affiliation(s)
- J Honório Palma
- Cardiovascular Surgery, Medical School, São Paulo Federal University, São Paulo, Brazil.
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Stolf NAG. On the originality of the technique described by Sueda and coworkers. Ann Thorac Surg 2002; 73:694. [PMID: 11848097 DOI: 10.1016/s0003-4975(01)03386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Stent-grafting and open graft replacement was introduced to reduce the complications of suture anastomosis in the descending aorta. We applied this technique in the treatment of a patient with multiple thoracic aneurysms. The elephant trunk procedure was used for thromboexclusion. A single branched graft was placed easily without twisting. In patients with aneurysms at both the proximal and distal thoracic aorta, combined stent-grafting and open graft replacement is an excellent approach.
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Affiliation(s)
- S Miyamoto
- Department of Cardiovascular Surgery, Oita Medical University, Japan.
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Kieffer E, Koskas F, Godet G, Bertrand M, Bahnini A, Benhamou AC, Cluzel P, Eyraud D. Treatment of aortic arch dissection using the elephant trunk technique. Ann Vasc Surg 2000; 14:612-9. [PMID: 11128456 DOI: 10.1007/s100169910111] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The elephant trunk technique was developed to facilitate multiple-stage treatment of extensive aneurysm of the thoracic aorta. However, little information is available concerning its usefulness for aortic dissection. From April 1992 to July 1998, we used the elephant trunk technique for treatment of aortic arch dissection in 22 patients (including 19 men) with a mean age of 58.5 years (range 21 to 85 years). Twelve patients presented with type A dissection (acute in 3 and chronic in 9), 3 with type B acute dissection, and 7 with "non A/non B" dissections with retrograde extension to the aortic arch or entry site located in the aortic arch without involvement of the ascending aorta. All patients had aneurysms of the descending (n = 7) or thoracoabdominal (n = 15) aorta. Procedures were performed under hypothermic circulatory arrest at between 15 degrees and 20 degrees C. Antegrade cerebral perfusion was used in three cases. The procedure was associated with aortic valve replacement and/or coronary bypass in 6 cases and bypass of one or more supraaortic vessels in 13. In two patients the distal end of the elephant trunk was attached with an endovascular prosthesis during the same procedure. The ensuing results in these patients indicate that the elephant trunk technique can be highly effective for treatment of complex aortic arch dissection.
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Affiliation(s)
- E Kieffer
- Departement d'Anesthésie-Réanimation, Pitié-Salpêtrière University Hospital, Paris, France
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Abstract
Extensive aneurysmal disease of the aorta presents considerable challenges to the cardiovascular surgeon and is generally treated with a staged approach. The elephant trunk principle, in which the downstream end of the primarily inserted graft is allowed to float freely in the downstream aorta, serves this approach. This principle greatly facilitates subsequent operation(s) and shortens the period of distal aortic occlusion. This review describes the state of the art of this technique, its various uses, and the results obtained.
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Affiliation(s)
- H G Borst
- Division of Thoracic and Cardiovascular Surgery, Surgical Centre, Hannover Medical School, Germany
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Stolf NA, Pêgo Fernandes PM, Souza LR, Moitinho R, Arteaga E, Jatene AD. Self-expanding endovascular stent-graft implant for treatment of descending aortic diseases. J Card Surg 1999; 14:9-15. [PMID: 10678440 DOI: 10.1111/j.1540-8191.1999.tb00944.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aneurysms and dissections involving the descending thoracic aorta and the distal portion of the aortic arch are difficult to resolve surgically. The introduction of endovascular self-expanding stent-grafts has simplified the operation. Given the complications associated with their peripheral placement, we explored the feasibility of surgical insertion. METHODS Thirteen patients underwent surgical insertion of a stent-graft into the aortic arch via longitudinal aortotomy. Six patients had aneurysms (ruptured in two, and seven dissections (acute in two, ruptured in one). Five patients also underwent associated procedures including aortic valve replacement (one), ascending aorta replacement (two), arch replacement (one), and coronary artery bypass (one). RESULTS There was one intraoperative death due to ascending aortic dissection, and two hospital deaths due to multiple complications. Of ten patients discharged, one died 3 months postoperatively. The remaining survivors are well, and imaging studies confirmed adequate correction of the aortic disease. CONCLUSIONS The use of this technique simplifies the operation and treatment of particular cases of aortic disease. The observed morbidity and mortality are due to factors independent of the technique.
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Affiliation(s)
- N A Stolf
- Heart Institute-INCOR University of Sao Paulo Medical Center, Brazil.
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Palma JH, Carvalho AC, Buffolo E, Almeida DR, Gomes WJ, Brasil LA. Endoscopic placement of stents in aneurysms of the descending thoracic aorta. Ann Thorac Surg 1998; 66:256-8. [PMID: 9692480 DOI: 10.1016/s0003-4975(98)00381-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This is a case of a patient with two saccular aneurysms in the descending aorta. Two self-expanding stents were inserted through an opening in the aortic arch, guided by the use of an Olympus endoscope, under profound hypothermia and total circulatory arrest. The bloodless field made possible the identification of the main thoracic branches, facilitating the positioning and deployment of both stents. Immediate postoperative recovery was excellent.
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Affiliation(s)
- J H Palma
- Division of Cardiovascular Surgery, Escola Paulista de Medicina, São Paulo, SP, Brazil.
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Sarsam MA. Repair of descending thoracic aortic dissection or aneurysm combined with repair of the proximal aorta via median sternotomy. J Card Surg 1998; 13:37-42. [PMID: 9892484 DOI: 10.1111/j.1540-8191.1998.tb01052.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A single-stage procedure for repair of the whole thoracic aorta via median sternotomy is described. The procedure is based on exposure of the descending aorta, posterior to the pericardium in the oblique sinus, or exposure of the aorta in the supracoeliac region and the placement of an endoprosthesis as an intraluminal graft. The ascending aorta and arch repair can be carried out as usual. The procedure has been performed in five patients with either dissection or aneurysm in the period between 1992 and 1997.
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Affiliation(s)
- M A Sarsam
- The Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, Northern Ireland
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Stolf NAG, Fernandes PMP, Souza LR, Moitinho R, Arteaga E, Jatene AD. Self-Expanding Endovascular Stent-Graft Implant for Treatment of Descending Aortic Diseases. Echocardiography 1985. [DOI: 10.1111/j.1540-8175.1985.tb01241.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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