aortic arch replacement using the frozen elephant trunk technique...
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Aortic arch replacement using the frozen
elephant trunk technique
F. Beyersdorf
Type of surgery Volume
Root/ ascending 124
Ascending/ hemiarch 19
Total arch (including FET) 35
TEVAR 43
EVAR 56
AAA classical surgery 87
TAAA classical surgery 17
Other 14
Total 395
The aortic programme 2015
UHZ Freiburg • Bad Krozingen
Czerny et al., EJCTS in press
Frozen Elephant Trunk Devices
• Gianturco Z-Stent (Cook, Inc.)
• Chavan-Haverich Prothesis (Curative GmbH)
• E-Vita open and E-Vita open Plus (Jotec GmbH)
• Cronus (Micro Post Medical Co.)
• Thoraflex Hybrid Prothesis (Vascutec, Terumo)
Thoraflex hybrid
Underlying diagnoses
• Acute type A aortic dissection
• Remaining type B after type A repair
• Aneurysmal formation- megaaortic syndrome
• Penetrating atherosclerotic ulcers
• Acute type B aortic dissection
Class of recommendation IIa
Level of evidence C
Acute type A aortic dissection-
distal entry/malperfusion
/
Preoperative CT scan
/
/
Postperative CT scan
Class of recommendation IIb
Level of evidence C
Acute type A aortic dissection-
aneurysm formation
Aneurysm of remaining type B
after previous type A repair
Evolving concept
/
Preoperative CT scan
/
Postoperative CT scan
Megaaortic syndrome
Class of recommendation IIa
Level of evidence C
Distal extension
Multiple penetrating atherosclerotic ulcers affecting
the entire thoracic aorta
Evolving concept
/
Preoperative CT scan
/
/
Postoperative CT scan
Complicated acute type B aortic dissection without a landing
zone for TEVAR, due to an ectatic aortic arch
Class of recommendation IIa
Level of evidence C
The Freiburg Experience:
FET – Aortic pathologies
FET-Implantation Freiburg Year
Aortic pathology 2015 2016
Dissection 21 20
Type A acute, n (%) 4 (19) 7 (35)
Type A chronic, n (%) 8 (38) 7 (35)
Type B acute, n (%) 4 (19) 2 (10)
Type B chronic, n (%) 2 (10) 0 (0)
Non-A-non-B acute, n (%) 1 (5) 2 (10)
Non-A-non-B chronic, n (%) 2 (10) 2 (10)
Aneurysm 8 12
Acute, n (%) 0 (0) 0 (0)
Chronic, n (%) 8 (100) 12 (100)
PAU (isolated) 0 1
Acute, n (%) 0 (0) 0 (0)
Chronic, n (%) 0 (0) 1 (100)
Total 29 33
Lowest body temperature, ± SD, °C 24.2±2.1
Operative times
CBP, ± SD, min 224±52
CX, ± SD, min 127±50
HCA, ± SD, min 48±32
SAP, ± SD, min 76±33
Concomitant procedures
Bentall, No. (%) 7 (11)
Valve sparing root, No. (%) 6 (10)
AVR, No. (%) 9 (15)
CABG, No. (%) 8 (13)
Other, No. (%) 4 (6)
Rethoracotomy, No. (%) 11 (18)
Disabling stroke, No. (%) 7 (11)
Paraplegia, No. (%) 0 (0)
Recurrent nerve palsy, No. (%) 3 (5)
Tracheotomy, No. (%) 4 (6)
Dialysis, No. (%) 8 (13)
ICU/IMC stay, ± SD, d 9.1±8.3
Hospital stay, ± SD, d 20.9±14.3
The Freiburg Experience:
FET – Operative Details
Outcome
Mean follow up, ± SD, m 9.73 ± 10.1
Survival, No. (%) 56 (90)
In hospital mortality, No. (%) 3 (5)
Mortality during follow up, No. (%) 3 (5)
Aortic reinterventions, No. (%) 9 (15)
TEVAR, No. (%) 8 (13)
Surgical thoracoabdominal aortic
replacement, No. (%)
1 (2)
The Freiburg Experience:
FET - Outcome
Summary
• FET broadenes indications and simplifies treatment
• The concept of obtaining most complete primary repair is
effective and facilitates secondary intervention
• Rate of symptomatic spinal cord ischemia may be
reduced by using the short stent-graft version
• A standardized approach makes the procedure safe and
reproducable