The elephant trunk is freezing: The Hannover experience
| Autor: | Felix Fleissner, Heike Krueger, Axel Haverich, Andreas Martens, Malakh Shrestha, Tim Kaufeld, Nurbol Koigeldiyev, Erik Beckmann, Julia Umminger, Fabio Ius |
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| Rok vydání: | 2015 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic arch Aortic dissection medicine.medical_specialty Aorta Elephant trunks business.industry Dissection (medical) medicine.disease Surgery Aortic aneurysm Aneurysm Anesthesia medicine.artery Descending aorta medicine Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 149:1286-1293 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2015.01.044 |
| Popis: | Background The "elephant trunk" (ET) technique traditionally has been performed to treat complex aortic diseases involving the aortic arch and the descending aorta. Despite the fact that, in recent years, the "frozen elephant trunk" (FET) technique has been used increasingly for such pathologies, discussion is still ongoing in the surgical community regarding which of the 2 techniques is better. We compared our results using the classic ET versus the FET technique. Methods From August 2001 to March 2013, a total of 277 patients underwent total aortic arch replacement and either ET (group A) or FET (group B) implantation. In group A, 97 patients (59 men; age 59.7 ± 12.7 years; 44.3% with aneurysm; 55.6% with dissection [48.45% acute]) underwent an ET procedure; 21.64% were reoperations. In group B, 180 patients underwent an FET procedure (126 men; age 59.8 ± 13.2 years; 34.4% with aneurysm; 63.3% with dissection [35% acute]); 30% were reoperations. Results In group A, in-hospital mortality was 24.7%; postoperative stroke rate was 12.4%. During follow-up, 27.8% underwent a second-stage procedure. In group B, in-hospital mortality was 12.2%; postoperative stroke rate was 13.3%. During follow-up, 27.7% patients underwent further interventions in the downstream aorta. Conclusions In selected patients with combined aortic arch and descending aortic aneurysms limited to the proximal descending aorta, the FET approach potentially allows for single-stage therapy, whereas a second-stage operation is inevitable with the classic ET approach. Moreover, owing to the availability of prefabricated, easy-to-use, FET, hybrid prostheses that result in significantly better outcomes in patients who have acute aortic dissection, type A, and if necessary, and provide an ideal "landing zone" for future endovascular completion, the classic ET procedure is "freezing," in the sense that it is being replaced by the FET approach. |
| Databáze: | OpenAIRE |
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