Minimally Invasive Approach For Frozen Elephant Trunk Surgery
Micaela De Palo, Manuela Conte, Antonio Massimo Cricco, Claudio Roscitano, Massimiliano Conte, Vincenzo Pastrichella, Gaetano Contegiacomo, Giampiero Esposito.
Mater Dei Hospital C.B.H., Bari, Italy.
OBJECTIVE: Frozen Elephant Trunk (FET) repair is currently the gold standard, despite its invasiveness, for single stage treatment of extensive aortic pathologies. Mini‐sternotomy advantages are well recognized. Antegrade cerebral perfusion provides an effective brain protection, but the spine and the lower body are exposed to a distal circulatory arrest (DCA). Distal aortic perfusion (DAP) is a popular technique for the repair of thoraco‐abdominal aneurysms and literature suggests its protective role for the spinal cord. Our objective was to report our experience with a new minimally invasive FET (Mini-FET).
METHODS: A retrospective analysis of surgical results with Mini‐FET technique was performed. In a three-year period, 59 patients underwent FET, 29 of which had a Mini‐FET. Mini-FET was characterized by a j‐shaped mini-sternotomy at 3rd/4th intercostal space, extended into a 2 cm left cervicotomy for better exposure of epiaortic vessels, and by antegrade DAP (ADAP): an ADAP catheter is placed into the FET stent graft to perfuse the lower spine and the visceral organs, thus reducing the DCA time to approximately 15 minutes, allowing a mild to moderate hypothermic cardiopulmonary bypass (CPB). Pathologies included in the analysis were aortic arch aneurysms extending into the descending aorta and acute/chronic Type B dissections with arch involvement.
RESULTS: Table1 shows patient’s characteristics and operative details. As regards post-operative outcomes, mortality was 0%. No major complications were observed, except for 2 patients (6.89%) who showed post-operative paraparesis. 17% of patients showed grade I acute kidney injury. ICU mean length of stay was 4.4±3.6 days.
CONCLUSIONS: In selected cases a Mini‐FET was a safe and feasible approach. The introduction of ADAP has allowed to shorten significantly the DCA time and to safely increase the CPB temperature up to 30‐32°C. The early results of this complex strategy appear promising, but the number of patients treated so far is still limited to draw a final conclusion on the advantages of Mini‐FET in terms of invasiveness and tolerability when compared to a conventional FET.
|Patients’ characteristics and Operative details||All (29) - Data expressed as % or mean±SD|
|Chronic Obstructive Pulmonary Disease||10 (34%)|
|Cardiopulmonary bypass time (min)||173±14|
|Aortic cross-clamping time (min)||79±8|
|Aortic Distal Arterial Perfusion (min)||24.2±4.5|
|Distal arrest (min)||14.1±4.1|
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