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Total Aortic Arch Replacement and Frozen Elephant Trunk.
Jacky Y K Ho1, Simon C Y Chow1, Micky W T Kwok1
1Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
Seminars in Thoracic and Cardiovascular Surgery
|November 12, 2020
Summary
This study shows excellent mid-term results for total arch replacement with frozen elephant trunk in aortic arch pathologies. Timely second-stage interventions improved outcomes, but distal stent graft issues need more research.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Aortic arch pathologies present significant surgical challenges requiring cerebral, visceral, and myocardial protection.
- Innovative techniques like total arch replacement and frozen elephant trunk have emerged with promising mid-term outcomes.
Purpose of the Study:
- To evaluate mid-term outcomes of total arch replacement with frozen elephant trunk.
- To assess the role of timely second-stage interventions in managing aortic arch pathologies.
Main Methods:
- Retrospective review of 41 patients undergoing total arch replacement with frozen elephant trunk (Thoraflex-Hybrid-Plexus device) between August 2014 and April 2020.
- Analysis of perioperative, clinical, and radiological outcomes, including survival, mortality, and procedural times.
- Evaluation of second-stage procedures and complications such as distal stent graft induced new entry.
Main Results:
- Overall survival was 85.3% at a median follow-up of 3.3 years, with 100% survival at 3 years post-discharge for 37 patients.
- Inpatient mortality was 9.8%. Common pathologies included acute type A dissection (36.6%), thoracic aortic aneurysms (22%), and chronic dissections (31.7%).
- Second-stage procedures were performed in 32% of patients; 19% experienced distal stent graft induced new entry.
Conclusions:
- Total arch replacement with frozen elephant trunk using the Thoraflex device demonstrates outstanding mid-term clinical outcomes in an Asian cohort.
- Timely second-stage interventions are crucial for managing descending aortic pathologies effectively.
- Further investigation is needed to understand aortic remodeling and the incidence of distal stent graft induced new entry.
