Hybrid arch frozen elephant trunk repair: evidence from the Canadian Thoracic Aortic Collaborative

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Abstract

Background

The frozen elephant trunk (FET) technique has become an increasingly popular strategy for aortic reconstruction in the setting of extensive thoracic aortic aneurysms or dissections. The objective of this study is to report on the Canadian experience with the FET technique in both the elective and emergent settings.

Methods

A total of 167 consecutive patients (mean age 65±13 years, 30% female, 25% re-operation) underwent elective (70%) and non-elective (30%) aortic arch reconstruction with the FET technique between May 2008 and October 2019 in six centers of the Canadian Thoracic Aortic Collaborative (CTAC). In-hospital clinical endpoints and early imaging endpoints were prospectively collected and analyzed.

Results

All 167 patients underwent successful FET implantation. In-hospital mortality occurred in 14 patients (8%), stroke occurred in 22 patients (13%) and temporary and permanent spinal cord ischemia (SCI) occurred in 6 (3.6%) and 3 (1.8%) patients, respectively. Prolonged mechanical ventilation was required in 35 patients (21%), renal failure requiring dialysis in 14 patients (8%) and atrial fibrillation in 59 patients (36%). The median hospital and intensive care unit (ICU) lengths of stay were 3 [interquartile range (IQR): 1, 6] and 10 (IQR: 7, 17) days, respectively. The rate of type 1A endoleak was 3.6%, with the lowest rate in patients who underwent a total arch replacement with a hybrid FET graft (0%) and the highest among patients who had a hemiarch with antegrade thoracic endovascular aortic repair (TEVAR) deployment (25%). The rate of other types of endoleak and stent complications was comparatively low.

Conclusions

The early CTAC experience with the FET operation demonstrates technical feasibility and good early clinical outcomes in elective and emergent patients. Further analysis is required to explore variations in technique and their potential impact on early and late outcomes.

Related collections

Author and article information

Journal

Journal ID (nlm-ta): Ann Cardiothorac Surg

Journal ID (iso-abbrev): Ann Cardiothorac Surg

Journal ID (publisher-id): ACS

Title: Annals of Cardiothoracic Surgery

Publisher: AME Publishing Company

ISSN (Print): 2225-319X

ISSN (Electronic): 2304-1021

Publication date (Print and electronic): May 2020

Publication date (Print): May 2020

Volume: 9

Issue: 3

Pages: 189-196

Affiliations

[1 ]Division of Cardiac Surgery, Department of Surgery, University of Toronto , Toronto, ON, Canada;

[2 ]Division of Cardiac Surgery, Department of Surgery, Western University , London, ON, Canada;

[3 ]Division of Cardiac Surgery, Department of Surgery, University of Montreal , Montreal, QC, Canada;

[4 ]Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicjne at Mount Sinai , New York, NY, USA;

[5 ]Division of Cardiac Surgery, Department of Surgery, Laval University , Quebec City, QC, Canada;

[6 ]Division of Cardiac Surgery, Department of Surgery, University of Ottawa , Ottawa, ON, Canada;

[7 ]Division of Cardiac Surgery, Ohio State University Wexner Medical Center , Columbus, OH, USA

Author notes

Correspondence to: Maral Ouzounian, MD, PhD, FRCSC. Associate Professor of Surgery, Peter Munk Cardiac Centre, University of Toronto, 200 Elizabeth St. 4N-464, Toronto, ON M5G 2C4, Canada. Email: Maral.Ouzounian@ 123456uhn.ca .

Article

Accession ID: PMC7298239 Pmcid ID: PMC7298239 Pmc-uid ID: 7298239 Publisher ID: acs-09-03-189

DOI: 10.21037/acs-2020-fet-22

PMC ID: 7298239

PubMed ID: 32551251

SO-VID: e786ba47-7636-4c01-931a-f775fd282b94

History

Date received : 18 January 2020

Date accepted : 05 May 2020

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