Taking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study
| Autor: | Zsuzsanna Arnold, Sandra Folkmann, Marieluise Harrer, Markus Mach, Bernhard Winkler, Heinrich Mächler, Daniela Geisler, Johannes Bonatti, Harald Pisarik, Martin Grabenwöger, Martin Czerny, Reinhard Moidl, Gabriel Weiss |
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| Rok vydání: | 2020 |
| Předmět: |
Eacts/164
Pulmonary and Respiratory Medicine Aortic arch medicine.medical_specialty Elephant trunks medicine.medical_treatment Eacts/161 Subclavian Artery Left subclavian artery side branch stent graft Aorta Thoracic 030204 cardiovascular system & hematology Prosthesis 03 medical and health sciences Blood Vessel Prosthesis Implantation 0302 clinical medicine Cadaver medicine.artery Germany medicine Conventional Aortic Surgery Frozen elephant trunk technique Humans Atrium (heart) Eacts/115 Aorta Aortic Aneurysm Thoracic AcademicSubjects/MED00920 business.industry Stent General Medicine Surgery Blood Vessel Prosthesis Editor's Choice Ostium Aortic Dissection medicine.anatomical_structure Treatment Outcome Anatomy of the aortic arch 030228 respiratory system Eacts/106 Feasibility Studies Stents Total aortic arch replacement Cardiology and Cardiovascular Medicine business Goals |
| Zdroj: | European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery |
| ISSN: | 1873-734X |
| Popis: | OBJECTIVES Our goal was to develop a modified frozen elephant trunk (FET) prosthesis with a stented left subclavian artery (LSA) side branch for LSA connection and to perform preclinical testing in a human cadaver model. METHODS We measured aortic diameters, distance between and diameters of supra-aortic vessels and the distance from the LSA offspring to the level of the left vertebral artery offspring in 70 patients. Based on these measurements, a novel FET prosthesis was developed (Cryolife/Jotec, Hechingen, Germany) featuring a stented side branch for an intrathoracic LSA connection. The feasibility and ease of implantation were tested in 2 human cadaver models at the Anatomical Institute of the Medical University Graz. A covered stent graft (Advanta V12™ by Atrium Medical Corp., Hudson, NH, USA) was used for an LSA extension. RESULTS Accurate deployment of the novel FET prosthesis with anatomical orientation of the stented side branch towards the LSA ostium followed by consecutive stent graft deployment was feasible in both cases. Proximalizing the distal anastomosis level from zone 3 to zone 1 not only diminished the complexity of the procedure but substantially facilitated the completion of the distal anastomosis. A 2.5-cm long extension stent graft was sufficient to seal to the LSA and to maintain left vertebral artery patency in both cases. CONCLUSIONS This initial study in human anatomical bodies could demonstrate the feasibility of implanting a newly designed FET prosthesis. This evolution of the FET technique has the potential to substantially ease total aortic arch replacement by proximalization of the distal anastomosis into zone 1 and by shortening spinal and lower body hypothermic circulatory arrest times via a stented side branch to the LSA. This direct connection enables early restoration of systemic perfusion. |
| Databáze: | OpenAIRE |
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