Soft Elephant Trunk Hybrid Prosthesis In Frozen Elephant Trunk Procedure: Midterm Results
Eduard Charchyan, Denis Breshenkov, Yuriy Belov.
Petrovskiy Russian Research Center of Surgery, Moscow, Russian Federation.
Background: To present the midterm results of frozen elephant trunk (FET) procedure in patients with extensive thoracic aortic diseases using a new hybrid prosthesis "Soft Elephant Trunk" (MedInzh, Penza, Russia).Material and methods: From 2015 to 2021, 170 patients underwent a total arch replacement using the FET technique. Of these, in 70 cases (since June 2019), we used a hybrid prosthesis "Soft Elephant Trunk". A feature of the new hybrid prosthesis is the tapered decreasing of the radial force of the nitinol crowns with the soft dacron distal end,= without radial force. In our opinion, this dissection-specific design can prevent of development of distal stent graft-induced new entry (dSINE). Study endpoints were hospital mortality, perioperative outcomes, and complications. Follow-up assessment included freedom from aortic reinterventions, freedom from dSINE, and long-term survival in the mid-term period.Results: There were Stanford type A aortic dissection in 51 cases (73.9%), Stanford type B aortic dissection in 13 (17.6%), thoracoabdominal aneurysm in 6 cases (8.5%). Of them, 14 cases (20%) were reoperation after prior proximal aorta repair. Also, we performed five mini-FET procedures (7.2%) through J-shaped mini-sternotomy. Acute aortic dissection was in 17 cases (24.3%). In most cases (n = 53 75.7%), we used separate branch technique, in other cases (n = 17, 24.3%) - en-block technique. Aortic root repair was performed in 21 (30%) cases, David procedure - 5 (7.14%) cases, Bentall-DeBono operation - 11 (15.7%), supracoronary ascending aortic replacement - 33 (47.1%). The cardiopulmonary bypass time, aortic cross-clamp time and circulatory arrest time were 130(104-160) min, 91(72.8-119) min, and 36(31-44) min, respectively. There were no cases of paraplegia. Respiratory failure was observed in 8 (11.4%) cases. Acute kidney injury, requiring temporary dialysis developed in 1 case (1,4%). Hospital mortality was 3 cases (4.2%), of which two patients with acute dissection were hemodynamically unstable due to ascending aortic rupture. Mean follow-up time was 9 (4,25 - 16) months. The 3-year survival rate was 94%(95 % CI: 88%-99,89%), freedom from reoperations was 96,6% (95 % CI: 90,1%-100%). There were no cases of dSINE. One year after the operation, two patients with connective tissue disorder (Marfan, Loys-Ditz syndromes) were required thoracoabdominal aortic replacement due to negative aortic remodelling.Conclusions: Rapid development hybrid technique in aortic arch surgery create new problems and complications. The "soft elephant trunk" hybrid prosthesis provides satisfactory results and can prevent specific stent graft-associated complications, thereby providing a stable long-term result. Dissection-specific stent graft with a soft distal end is safe and effective in patients with thoracic aortic pathology. However, to determine the potential advantages of the new hybrid prosthesis, further research and long-term results are needed. 
| N (%)/mean ± SD/median (Q1-Q3) | А(n=51) | В(n=13) | ТААА(n=6) | p |
| AKI | 5(9,8) | 2(15,4) | 1(16,7) | 0,78 |
| Stroke | 1(2) | 0 | 0 | 0,828 |
| Postoperative dialysis | 0 | 1(7,7) | 0 | 0,555 |
| Paraplegia | 0 | 0 | 0 | 1 |
| Re-exploration for bleeding | 1(2) | 1(7,7) | 0 | 0,492 |
| Respiratory failure | 7(13,7) | 1(7,7) | 0 | 0,544 |
| Rate of re-surgery | 2(3,9) | 2(15,4) | 0 | 0,232 |
| Mean FU, months | 7(3-13) | 10(7-17) | 12(8,25-15,8) | 0.256 |
| Hospital mortality | 3(5,8) | 0 | 0 | 0,568 |
Back to 2022 Abstracts