[The Thoracoflo Graft for Hybrid TAAA Repair - Tips and Tricks After the First Clinical Experience]

The Thoracoflo hybridgraft was developed for treatment of thoracoabdominal aortic pathologies in selective patients, avoiding thoracotomy, thoracic cross-clamping, and extracorporeal circulation (ECC). In the following manuscript, criteria for patient selection as well as pitfalls and bailouts after first clinical experience are summarised.Since September 2021, worldwide a total of 50 Thoracoflo implantations have been performed in centres with high experience in open and endovascular treatment of thoracoabdominal aortic pathologies. All patients were selected by interdisciplinary board decision. Conventional open or solely endovascular repair was not feasible or at high risk due to comorbidities or for anatomical reasons. Simulator team training was performed prior to surgery and the procedure was supervised by a proctor. All procedures were evaluated postoperatively for technical and surgical pitfalls, and consecutive bailouts were elaborated and summarised.Requirements for graft implantation are a safe landing zone in the descending thoracic aorta, which can also be created by TEVAR implantation, and possibility for retrograde visceral perfusion (access to visceral arteries in dissection, low thrombus load). The Thoracoflo hybridgraft was successfully implanted in 49 out of 50 patients, but in one procedure intraoperative conversion with thoracotomy and extracorporeal circulation was necessary. During debriefing pitfalls and bailouts were summarised.The Thoracoflo hybridgraft offers an alternative treatment option for complex aortic pathologies, if perioperative requirements are followed. Accurate patient selection and verification of treatment indication are mandatory.