Complex thoracic aortic disease: Single-stage procedure with the frozen elephant trunk technique

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• 作者：Roberto Di Bartolomeo ; Davide Pacini ; Carlo Savini ; Emanuele Pilato ; Sofia Martin-Suarez ; Luca Di Marco ; Marco Di Eusanio
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2010
• 出版时间：December 2010
• 年：2010
• 卷：140
• 期：6, Supplement 1
• 页码：S81-S85

文摘

Objective

Extensive thoracic aortic aneurysms represent a challenging pathology in cardiac surgery. The frozen elephant trunk procedure, combining conventional surgery with endovascular techniques, allows single-stage treatment for such pathology. Here we present our surgical technique and results with the single-stage frozen elephant trunk procedure.

Methods

Between January 2007 and December 2009, 67 patients were treated with the frozen elephant trunk procedure in our institution. Mean age was 61 ± 11 years. Indications for surgery included chronic aneurysm (n = 22, 32.8 % ), acute type A dissection (n = 4, 6.0 % ), acute type B dissection (n = 2, 3.0 % ), chronic type A dissection (n = 30, 44.8 % ), and chronic type B dissection (n = 9, 13.4 % ). Thirty-six patients (53.7 % ) had undergone 38 previous cardiac or aortic operations. Thirty-two associated aortic and cardiac operations were performed. Brain protection was achieved by means of antegrade selective cerebral perfusion and moderate hypothermia (26°C) in all cases.

Results

In-hospital mortality was 13.4 % . Postoperatively, permanent neurologic dysfunction (coma) occurred in 5 cases (7.5 % ), paraplegia in 2 (3.2 % ), and paraparesis in 3 (4.9 % ). Follow-up was 100 % complete, with mean duration of 11.1 ± 8.4 months. The 1- and 2-year survivals were 76.7 ± 5.6 % and 70.3 ± 8.0 % , respectively. Ten patients (14.9 % ) required endovascular completion 2.3 ± 3.1 months after the first procedure, with 100 % technical and procedural success.

Conclusions

In contrast to the conventional elephant trunk technique, the frozen elephant trunk technique offers a potentially curative single-stage procedure for patients with extensive thoracic aortic disease, with encouraging short-term and midterm results.