Staging TEVAR after FET - an exception or the rule?

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Frozen elephant trunk (FET) is a one-step procedure for complex aortic arch and descending thoracic aorta pathologies.
• Reintervention after FET is common, often facilitated by TEVAR extension due to the safe landing zone provided by FET.

Purpose of the Study:

• To describe the experience, indications, technique, and outcomes of TEVAR extension following FET procedures.
• To evaluate the safety and efficacy of TEVAR extension in managing complex aortic conditions after FET.

Main Methods:

• Retrospective analysis of 371 patients who underwent FET between 2007 and 2022.
• Detailed review of 154 TEVAR extension procedures in 119 patients, including urgent cases.
• Analysis of preoperative characteristics, indications, and short-, mid-, and long-term outcomes.

Main Results:

• 154 TEVAR extensions were performed in 119 patients, with a mean follow-up time of 22.2 months.
• Excellent survival rates: 96.2% at 1 year, 93.9% at 2 years, 90.1% at 5 years, and 70.5% at 10 years.
• No significant difference in TEVAR extension rates based on graft type (Thoraflex™ vs. E-vita™) or anastomosis zone.

Conclusions:

• TEVAR extension after FET is a safe and effective procedure for treating complex aortic pathologies.
• The technique offers excellent short-, mid-, and long-term postoperative outcomes.
• Rigorous follow-up is crucial to determine the optimal timing for TEVAR extension after FET.