Single-Stage Treatment of Extensive Aortic Pathology Using the Frozen Elephant Trunk Procedure

Authors

  • Petar Risteski Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
  • Vasil Papestiev University Clinic for Cardiac Surgery, Skopje, North Macedonia
  • Stefanija Hadzievska University Clinic for Cardiac Surgery, Skopje, North Macedonia
  • Nadica Mehmedovic University Clinic for Cardiac Surgery, Skopje, North Macedonia
  • Nikola Lazovski University Clinic for Cardiac Surgery, Skopje, North Macedonia
  • Zan Zimbakov University Clinic for Cardiology, Skopje, North Macedonia
  • Venko Filipce University Clinic for Neurosurgery, Skopje, North Macedonia
  • Marjan Shokarovski University Clinic for Cardiac Surgery, Skopje, North Macedonia

DOI:

https://doi.org/10.1532/hsf.3063

Keywords:

Frozen elephant trunk, Aortic arch, Aneurysm, Aorta, aortic dissection

Abstract

Background: Extensive pathology involving the aortic arch and descending aorta traditionally has been treated with two open procedures. We report our institutional experience with a single stage frozen elephant trunk procedure for treatment of extensive aortic pathology.

Methods: Between June 2018 and October 2019, nine patients (eight males, 89%, mean age 61 ± 6 years) with extensive aortic pathology were operated using the frozen elephant trunk procedure. Five (56%) patients underwent primary operation for chronic arch and proximal descending aneurysm in two (22%) patients, chronic type B aortic dissection in two (22%) patients and penetrating aortic ulcer in one (11%) patient. The other four (44%) patients received reoperative surgery for chronic post-dissection aneurysms. For organ protection during the aortic arch procedure, we used selective antegrade cerebral perfusion and mild systemic hypothermia at 28°C.

Results: Early mortality was not observed. A single (11%) patient developed focal stroke. Unilateral vocal cord palsy was present in two (22%) patients. Spinal cord injury was not observed. Reexploration for bleeding was required in two (22%) patients. Prolonged ventilation, liver and kidney failure as well as cardiac morbidity were not observed. Two patients (22%) with anticipated Endoleak type Ib received TEVAR extension at follow up. Mid-term mortality was observed in two (22%) patients, due to pneumonia.

Conclusion: The frozen elephant trunk procedure can be used for a single-stage treatment of patients with extensive aortic pathology, due to chronic degenerative aneurysms or post-dissection aneurysms involving the aortic arch and the descending aorta, with acceptable mortality and morbidity.

References

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Published

2020-08-28

How to Cite

Risteski, P., Papestiev, V., Hadzievska, S., Mehmedovic, N., Lazovski, N., Zimbakov, Z., Filipce, V., & Shokarovski, M. (2020). Single-Stage Treatment of Extensive Aortic Pathology Using the Frozen Elephant Trunk Procedure. The Heart Surgery Forum, 23(5), E606-E610. https://doi.org/10.1532/hsf.3063

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