Back to Annual Meeting Program

Objective: to compare the outcome of one-stage frozen elephant trunk (FET) technique to two stages “Lupiae” technique (surgical “fixed” elephant trunk) performed in hybrid repair of extensive thoracic aortic disease involving the ascending aorta, arch and proximal descending aorta with different aetiologies.
Methods: Fifty-six consecutive patients with extensive thoracic aortic aneurysms were treated with one stage (FET) or two stage (Lupiae) hybrid approach between 2004 and 2008: eighteen patients underwent FET and 38 Lupiae repair. All the procedures were performed by a single surgeon on cardiopulmonary bypass (CPB), antegrade selective cerebral perfusion (ASCP) and distal circulatory arrest (DCA).
Results: CPB was 194 ± 41 min vs. 122.6 ± 35 min (p < 0.0001) X-clamp time was 101±22 min vs. 61,3±22,4 min (p<0.0001), ASCP was 92±15 min vs. 75±12 min (p<0.0001) and DCA was 73±14 vs. 28.1±6.7 (p<0.0001) in the FET and Lupiae group respectively. 30-days mortality was 11.1% vs. 7.7% (p=0.65) and spinal cord ischemia 16.6% vs. 0% (p=0.03) in FET and Lupiae group respectively. The second endovascular stage in the Lupiae group was performed in all (35/38) the survived patients. During the three-year follow-up one patient died in the Lupiae group and 5 in the FET group (p=0.009). The incidence of Type Ia endovascular leaks was 31.2% and 2.8% for FET and Lupiae group respectively (p=0.009)
Conclusions: the hybrid fixed elephant trunk “Lupiae” technique in comparison with FET technique achieves superior results in term of avoidance of secondary endovascular procedures due to distal endoleaks and 3-year survival. Additional studies will be needed to validate the hybrid thoracic aortic aneurysm repair paradigm.