ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Pitfall Of Frozen Elephant Trunk Procedure; Our Experience Of 54 Cases
Yoshito Sakon1, Takashi Murakami1, Takeshi Ikuta2, Mitsuharu Hosono3, Takanori Tokuda4, Shinsuke Kotani5, Hiromichi Fujii1, Yosuke Takahashi1, Shinsuke Nishimura1, Daisuke Yasumizu1, Toshihiko Shibata1.
1Osaka City University Graduate School of Medicine, Osaka, Japan, 2Ishikiri Seiki Hospital, Higashiosaka, Japan, 3Kansai Medical University Medical Center, Osaka, Japan, 4Hirakata Kousai Hospital, Osaka, Japan, 5Belland General Hospital, Osaka, Japan.

OBJECTIVE: Frozen elephant trunk (FET) procedure has recently been increasingly performed, but there are some FET specific complications. We retrospectively analyzed the complications related to this procedure using multi-center registry database.
METHODS: 54 patients who underwent FET between January 2001 and September 2016 were eligible for analysis. The mean age of the cohort was 70.9±10.3 years (77.8% male). Indication was true aneurysm in 43 cases (79.6%), chronic aortic dissection in 3 (5.6%), and acute aortic dissection in 8 (14.8%). Handmade composite grafts with Gianturco Cook-Z Stent (Cook Medical; Bloomington, IN, USA) were used in 17 patients until December 2013, followed by the commercially available J Graft Open Stent Graft (Japan Lifeline; Shinagawa, Tokyo, JPN) in 36 cases. Conformable TAG Thoracic Endoprosthesis (W. L. Gore & Associates; Flagstaff, AZ, USA) was used in one patient. Proximal anastomosis site of FET was Zone 0 in 9 cases (16.6%), Zone 2 in 24 cases (44.4%), and Zone 3 in 2 cases (3.7%). 33 patients (61.1%) had concomitant graft replacement of the aortic arch, whereas other patients had FET insertion through anterior half incision of aortic wall (inclusion method).
RESULTS: 4 patients died during hospitalization. One FET-related cause of death was graft kinking and occlusion at the transition from non-stented to stented graft, leading to malperfusion and multiple organ failure. Another FET-related cause of death was bleeding after inclusion method, requiring second circulatory arrest. Complications related to FET procedure were paraplegia in 3 cases (5.6%), graft kinking in 2 cases (one of which was presented above, and another patient had endovascular re-intervention), ascending aortic dissection after inclusion method in 1 case (1.6%), and FET inserted into false lumen in 1 case.
CONCLUSIONS: FET technique was developed expecting less surgical burden, however, several FET-specific complications were recognized, which have to be conquered by a surgeon technically and also with device technology advancement.


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