The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta

A multicenter experience

Davide Pacini, Konstantinos Tsagakis, Heinz Jakob, Carlos A. Mestres, Alessandro Armaro, Gabriel Weiss, Martin Grabenwoger, Michael A. Borger, Friedrich W. Mohr, Robert Stuart Bonser, Roberto Di Bartolomeo

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique. Methods: Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry. Ninety of the patients, who were the population in the present study, underwent operations for chronic dissection of the aorta (type A, 77%). The mean age of these 90 patients was 57 ± 12 years, and 72 (80%) of the patients were male. Sixty-two patients (69%) had undergone a previous aortic operation. All of the procedures in the study were performed with the aid of antegrade selective cerebral perfusion. Results: Total replacement of the aortic arch was done in 84 patients (93%). Cardiopulmonary bypass, myocardial ischemia, cerebral perfusion, and visceral ischemia times were 243 ± 65, 145 ± 48, 86 ± 24, and 75 ± 22 minutes, respectively. In-hospital mortality was 12% (11 patients). One patient died from a stroke and 8 patients (9%) died from ischemic spinal cord injury. The false lumen (FL) in the patients' aortae was evaluated with computed tomography after operation and during follow up. The rates of complete thrombosis of the FL around the elephant trunk were 69% and 79% at the first and last postoperative examinations, respectively. The rates of 4-year survival and freedom from aortic reoperation were 78% ± 5% and 96% ± 3%, respectively. Conclusions: The treatment of chronic aortic dissection (AD) with the FET technique is feasible, with respectable results. The rate of aortic reoperation with the use of this technique appears to be lower than that with a conventional approach to the repair of chronic AD. Ischemic spinal cord injury represents a concerning complication of the FET technique but seems to be unrelated to thrombosis of the FL.

Original languageEnglish
Pages (from-to)1663-1670
Number of pages8
JournalAnnals of Thoracic Surgery
Volume92
Issue number5
DOIs
Publication statusPublished - Nov 2011

Fingerprint

Thoracic Aorta
Dissection
Therapeutics
Aorta
Spinal Cord Injuries
Reoperation
Thrombosis
Perfusion
Hospital Mortality
Cardiopulmonary Bypass
Multicenter Studies
Myocardial Ischemia
Registries
Ischemia
Stroke
Tomography
Pathology
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta : A multicenter experience. / Pacini, Davide; Tsagakis, Konstantinos; Jakob, Heinz; Mestres, Carlos A.; Armaro, Alessandro; Weiss, Gabriel; Grabenwoger, Martin; Borger, Michael A.; Mohr, Friedrich W.; Bonser, Robert Stuart; Di Bartolomeo, Roberto.

In: Annals of Thoracic Surgery, Vol. 92, No. 5, 11.2011, p. 1663-1670.

Research output: Contribution to journalArticle

Pacini, D, Tsagakis, K, Jakob, H, Mestres, CA, Armaro, A, Weiss, G, Grabenwoger, M, Borger, MA, Mohr, FW, Bonser, RS & Di Bartolomeo, R 2011, 'The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: A multicenter experience', Annals of Thoracic Surgery, vol. 92, no. 5, pp. 1663-1670. https://doi.org/10.1016/j.athoracsur.2011.06.027
Pacini, Davide ; Tsagakis, Konstantinos ; Jakob, Heinz ; Mestres, Carlos A. ; Armaro, Alessandro ; Weiss, Gabriel ; Grabenwoger, Martin ; Borger, Michael A. ; Mohr, Friedrich W. ; Bonser, Robert Stuart ; Di Bartolomeo, Roberto. / The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta : A multicenter experience. In: Annals of Thoracic Surgery. 2011 ; Vol. 92, No. 5. pp. 1663-1670.
@article{c3fadade79934c53a32cb9a306fcc58a,
title = "The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: A multicenter experience",
abstract = "Background: Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique. Methods: Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry. Ninety of the patients, who were the population in the present study, underwent operations for chronic dissection of the aorta (type A, 77{\%}). The mean age of these 90 patients was 57 ± 12 years, and 72 (80{\%}) of the patients were male. Sixty-two patients (69{\%}) had undergone a previous aortic operation. All of the procedures in the study were performed with the aid of antegrade selective cerebral perfusion. Results: Total replacement of the aortic arch was done in 84 patients (93{\%}). Cardiopulmonary bypass, myocardial ischemia, cerebral perfusion, and visceral ischemia times were 243 ± 65, 145 ± 48, 86 ± 24, and 75 ± 22 minutes, respectively. In-hospital mortality was 12{\%} (11 patients). One patient died from a stroke and 8 patients (9{\%}) died from ischemic spinal cord injury. The false lumen (FL) in the patients' aortae was evaluated with computed tomography after operation and during follow up. The rates of complete thrombosis of the FL around the elephant trunk were 69{\%} and 79{\%} at the first and last postoperative examinations, respectively. The rates of 4-year survival and freedom from aortic reoperation were 78{\%} ± 5{\%} and 96{\%} ± 3{\%}, respectively. Conclusions: The treatment of chronic aortic dissection (AD) with the FET technique is feasible, with respectable results. The rate of aortic reoperation with the use of this technique appears to be lower than that with a conventional approach to the repair of chronic AD. Ischemic spinal cord injury represents a concerning complication of the FET technique but seems to be unrelated to thrombosis of the FL.",
author = "Davide Pacini and Konstantinos Tsagakis and Heinz Jakob and Mestres, {Carlos A.} and Alessandro Armaro and Gabriel Weiss and Martin Grabenwoger and Borger, {Michael A.} and Mohr, {Friedrich W.} and Bonser, {Robert Stuart} and {Di Bartolomeo}, Roberto",
year = "2011",
month = "11",
doi = "10.1016/j.athoracsur.2011.06.027",
language = "English",
volume = "92",
pages = "1663--1670",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "The Society of Thoracic Surgeons. Published by Elsevier Inc",
number = "5",

}

TY - JOUR

T1 - The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta

T2 - A multicenter experience

AU - Pacini, Davide

AU - Tsagakis, Konstantinos

AU - Jakob, Heinz

AU - Mestres, Carlos A.

AU - Armaro, Alessandro

AU - Weiss, Gabriel

AU - Grabenwoger, Martin

AU - Borger, Michael A.

AU - Mohr, Friedrich W.

AU - Bonser, Robert Stuart

AU - Di Bartolomeo, Roberto

PY - 2011/11

Y1 - 2011/11

N2 - Background: Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique. Methods: Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry. Ninety of the patients, who were the population in the present study, underwent operations for chronic dissection of the aorta (type A, 77%). The mean age of these 90 patients was 57 ± 12 years, and 72 (80%) of the patients were male. Sixty-two patients (69%) had undergone a previous aortic operation. All of the procedures in the study were performed with the aid of antegrade selective cerebral perfusion. Results: Total replacement of the aortic arch was done in 84 patients (93%). Cardiopulmonary bypass, myocardial ischemia, cerebral perfusion, and visceral ischemia times were 243 ± 65, 145 ± 48, 86 ± 24, and 75 ± 22 minutes, respectively. In-hospital mortality was 12% (11 patients). One patient died from a stroke and 8 patients (9%) died from ischemic spinal cord injury. The false lumen (FL) in the patients' aortae was evaluated with computed tomography after operation and during follow up. The rates of complete thrombosis of the FL around the elephant trunk were 69% and 79% at the first and last postoperative examinations, respectively. The rates of 4-year survival and freedom from aortic reoperation were 78% ± 5% and 96% ± 3%, respectively. Conclusions: The treatment of chronic aortic dissection (AD) with the FET technique is feasible, with respectable results. The rate of aortic reoperation with the use of this technique appears to be lower than that with a conventional approach to the repair of chronic AD. Ischemic spinal cord injury represents a concerning complication of the FET technique but seems to be unrelated to thrombosis of the FL.

AB - Background: Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique. Methods: Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry. Ninety of the patients, who were the population in the present study, underwent operations for chronic dissection of the aorta (type A, 77%). The mean age of these 90 patients was 57 ± 12 years, and 72 (80%) of the patients were male. Sixty-two patients (69%) had undergone a previous aortic operation. All of the procedures in the study were performed with the aid of antegrade selective cerebral perfusion. Results: Total replacement of the aortic arch was done in 84 patients (93%). Cardiopulmonary bypass, myocardial ischemia, cerebral perfusion, and visceral ischemia times were 243 ± 65, 145 ± 48, 86 ± 24, and 75 ± 22 minutes, respectively. In-hospital mortality was 12% (11 patients). One patient died from a stroke and 8 patients (9%) died from ischemic spinal cord injury. The false lumen (FL) in the patients' aortae was evaluated with computed tomography after operation and during follow up. The rates of complete thrombosis of the FL around the elephant trunk were 69% and 79% at the first and last postoperative examinations, respectively. The rates of 4-year survival and freedom from aortic reoperation were 78% ± 5% and 96% ± 3%, respectively. Conclusions: The treatment of chronic aortic dissection (AD) with the FET technique is feasible, with respectable results. The rate of aortic reoperation with the use of this technique appears to be lower than that with a conventional approach to the repair of chronic AD. Ischemic spinal cord injury represents a concerning complication of the FET technique but seems to be unrelated to thrombosis of the FL.

UR - http://www.scopus.com/inward/record.url?scp=80155194318&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80155194318&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2011.06.027

DO - 10.1016/j.athoracsur.2011.06.027

M3 - Article

VL - 92

SP - 1663

EP - 1670

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 5

ER -