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OBJECTIVE: The frozen elephant trunk (FET) technique has been conceived to treat complex aortic pathologies (CAP) such as degenerative or dissecting aneurysms involving the aortic arch and descending aorta as a potential 'single-stage' procedure. Few different devices are available to perform the FET. We report our early experience with the new hybrid device ThoraflexTM (Vascutek, Scotland).
METHODS: Since September 2013, three patients (mean age 69±12.1 years) underwent one stage FET surgery for CAP. The first case was a redux chronic aortic dissection with aneurysmal evolution of the arch and descending aorta. The second was a double thoracic aortic aneurysm (ascending aorta/proximal arch and descending aorta). The third was an important descending aorta aneurysm (9 cm) with TEVAR contra-indication. During circulatory arrest and selective antegrade cerebral perfusion, the collapsed endoprosthesis was deployed into the descending aorta through the opened aortic arch. Ischemic and operative times as well as adverse events were monitored.
RESULTS: The proximal 4-branched graft was appreciated for its sewing collar, which facilitates and makes safe the distal anastomosis. Moreover it allows a separate reimplantation of the arch vessels potentially reducing the ischemic time. The FET procedure was performed in all cases without technical problems. The CPB time was 231.6±10.5 min, aortic cross clamp time was 131.6±28.5 min and circulatory arrest time was 95.5±33.2 min. Postoperative course was uneventful. Postoperative CT-scans confirmed the desired results.
CONCLUSIONS: The new hybrid device ThoraflexTM adds to the armament of the surgeon in the treatment of CAP. Its particular features can potentially make the FET procedure safer and easier.