Total Aortic Arch Replacement With Frozen Elephant Trunk: The Prince Of Wales Hospital Of Hong Kong Experience
Jacky YK Ho, Simon CY Chow, Peter SY Yu, Micky WT Kwok, Song Wan, Malcolm Underwood, Randolph HL Wong.
Prince of Wales Hospital, Hong Kong, Hong Kong, Hong Kong.
BACKGROUND Aortic arch pathology commonly involves multiple segments of the aorta and the supra-aortic branches, leading to malperfusion insults, hence, to be one of the most challenging conditions. We reviewed our experience on total aortic arch replacement and frozen elephant trunk (FET) with a one-piece hybrid stent graft system, allowing a single stage option of complex arch pathologies.
METHODS Between August 2014 and November 2017 at the Prince of Wales Hospital Hong Kong, patients underwent total aortic arch replacement with FET by the commercially available one-piece hybrid stent graft system were recruited. Patients' perioperative parameters, clinical and radiological outcomes were reviewed.
RESULTS Twenty-eight patients, including acute dissections and chronic dissecting aneurysms, were recruited with 28% (n=8) performed with concomitant procedures. Overall mortality rate was 7.1% (n=2) with a zero percent of 30-days mortality in the elective subgroup (60%). One patient (3.6%) developed stroke otherwise with no recorded permanent spinal cord injury. Mean operative, moderate hypothermic circulatory arrest and antegrade cerebral perfusion time were 437±125 min, 91±27 min, and 148±42 min respectively. Two patients (7.1%) developed stent-induced distal entry (SINE) required second staged endovascular treatment and 1 developed mal-deployment salvaged by the endovascular approach.
CONCLUSIONS This series represents one of the largest single-center experience of the one-piece hybrid stent graft system in Asia. We demonstrated its use to be safe and effective in the pathologies involving aortic arch and multiple segments, even with concomitant procedures. Further study is warranted to evaluate its impact on survival and disease progression in descending thoracic aorta especially on the development of SINE.
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