Frozen Elephant Trunk Sizing: A 30,000-Feet Perspective with Thoraflex Hybrid Stent Graft

Abstract

There is currently no standard, evidence-based approach for sizing the Thoraflex Hybrid prosthesis in frozen elephant trunk surgery. We present regional data on 906 Thoraflex grafts implanted in the United Kingdom between December 2012 and August 2021 to emphasize the heterogeneity in sizing practices and evaluate the impact this may have on clinical outcomes. Highlighting this heterogeneity will help develop an evidence-based approach to prosthesis sizing, thereby aiding decision-making for arch repair.

Keywords

frozen elephant trunk - Thoraflex Hybrid prosthesis - sizing - aorta - dissection - aneurysm

Publikationsverlauf

Eingereicht: 28. September 2021

Angenommen: 06. Juli 2022

Artikel online veröffentlicht:
15. Dezember 2022

• References

• 1 Sampson UK, Norman PE, Fowkes FG. et al. Global and regional burden of aortic dissection and aneurysms: mortality trends in 21 world regions, 1990 to 2010. Glob Heart 2014; 9 (01) 171-180.e10
• 2 Tan SZ, Jubouri M, Mohammed I, Bashir M. What is the long-term clinical efficacy of the Thoraflex Hybrid prosthesis for aortic arch repair?. Front Cardiovasc Med 2022; 9: 842165
• 3 Bashir M, Abo Aljadayel H, Mousavizadeh M. et al. Correlation of coagulopathy and frozen elephant trunk use in aortic arch surgery: a systematic review and meta-analysis. J Card Surg 2021; 36 (12) 4699-4714
• 4 Tan SZCP, Lopuszko A, Munir W, Adams B, Bashir M. Aortic proximalization-zone 0 versus zone 2: a concept or true challenge?. J Card Surg 2021; 36 (09) 3319-3325
• 5 Yamamoto H, Kadohama T, Yamaura G. et al. Total arch repair with frozen elephant trunk using the “zone 0 arch repair” strategy for Type A acute aortic dissection. J Thorac Cardiovasc Surg 2020; 159 (01) 36-45
• 6 Panfilov DS, Kozlov BN, Pryakhin AS, Kopeva KV. Frozen elephant trunk technique with different proximal landing zone for aortic dissection. Interact Cardiovasc Thorac Surg 2021; 33 (02) 286-292
• 7 Choudhury RY, Basharat K, Zahra SA. et al. “Proximalization is advancement”—zone 3 frozen elephant trunk vs zone 2 frozen elephant trunk: a literature review. Vasc Endovascular Surg 2021; 55 (06) 612-618
• 8 Damberg A, Schälte G, Autschbach R, Hoffman A. Safety and pitfalls in frozen elephant trunk implantation. Ann Cardiothorac Surg 2013; 2 (05) 669-676
• 9 Idhrees M, Bashir M, Jakob H. Right size matters! The ideal size of hybrid prosthesis in frozen elephant trunk. Asian Cardiovasc Thorac Ann 2021; 29 (07) 619-622
• 10 Mohammed I, Tan SZ, Jubouri M, Shaw M, Bashir M. Institutional practice in sizing of the hybrid prosthesis in frozen elephant trunk surgery. J Cardiovasc Surg (Torino) 2022
• 11 Tsagakis K, Jakob H. Which frozen elephant trunk offers the optimal solution? Reflections from Essen group. Semin Thorac Cardiovasc Surg 2019; 31 (04) 679-685
• 12 Gorlitzer M, Weiss G, Meinhart J. et al. Fate of the false lumen after combined surgical and endovascular repair treating Stanford type A aortic dissections. Ann Thorac Surg 2010; 89 (03) 794-799
• 13 Katayama A, Uchida N, Katayama K, Arakawa M, Sueda T. The frozen elephant trunk technique for acute Type A aortic dissection: results from 15 years of experience. Eur J Cardiothorac Surg 2015; 47 (02) 355-360 , discussion 360
• 14 Kreibich M, Berger T, Rylski B. et al. Aortic reinterventions after the frozen elephant trunk procedure. J Thorac Cardiovasc Surg 2020; 159 (02) 392-399.e1
• 15 Leontyev S, Borger MA, Etz CD. et al. Experience with the conventional and frozen elephant trunk techniques: a single-centre study. Eur J Cardiothorac Surg 2013; 44 (06) 1076-1082
• 16 Pacini D, Tsagakis K, Jakob H. et al. The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: a multicenter experience. Ann Thorac Surg 2011; 92 (05) 1663-1670
• 17 Kandola S, Abdulsalam A, Field M, Fisher RK. Frozen elephant trunk repair of aortic aneurysms: how to reduce the incidence of endoleak and reintervention. JTCVS Tech 2020; 3: 13-20
• 18 Ho JYK, Lim K, Fujikawa T, Wong RHL. Pre-emptive BioGlue priming of the branched Evita Open NEO hybrid prosthesis: tackling excessive oozing. Eur J Cardiothorac Surg 2022; 61 (03) 728-729
• 19 Czerny M, Kreibich M, Morlock J. et al. Chronic type B “residual” after type A: what I would do?. J Vis Surg 2018; 4: 14
• 20 Chu MWA, Losenno KL, Dubois LA. et al; Canadian Thoracic Aortic Collaborative (CTAC) Investigators. Early clinical outcomes of hybrid arch frozen elephant trunk repair with the Thoraflex Hybrid graft. Ann Thorac Surg 2019; 107 (01) 47-53
• 21 Di Bartolomeo R, Di Marco L, Cefarelli M. et al. The Bologna experience with the Thoraflex hybrid frozen elephant trunk device. Future Cardiol 2015; 11 (01) 39-43
• 22 Toyama M, Usui A, Yoshikawa M, Ueda Y. Thoracic aneurysm rupture due to graft perforation after endovascular stent-grafting via median sternotomy. Eur J Cardiothorac Surg 2005; 27 (01) 162-164
• 23 Hoffman A, Damberg ALM, Schälte G, Mahnken AH, Raweh A, Autschbach R. Thoracic stent graft sizing for frozen elephant trunk repair in acute Type A dissection. J Thorac Cardiovasc Surg 2013; 145 (04) 964-969.e1
• 24 Umana-Pizano JB, Nissen AP, Sandhu HK. et al. Acute Type A dissection repair by high-volume vs low-volume surgeons at a high-volume aortic center. Ann Thorac Surg 2019; 108 (05) 1330-1336
• 25 Bridgewater B, Keogh B, Kinsman R, Walton P. Society for Cardiothoracic Surgery in Great Britain and Ireland. Sixth National Adult Cardiac Surgical Database Report 2008. Demonstrating Quality. Accessed September 1, 2022 at: https://scts.org/_userfiles/pages/files/sixthnacsdreport2008withcovers.pdf