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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.

Postoperative results
N (%)/mean SD/median (Q1-Q3)А(n=51)В(n=13)ТААА(n=6)p
Postoperative dialysis01(7,7)00,555
Re-exploration for bleeding1(2)1(7,7)00,492
Respiratory failure7(13,7)1(7,7)00,544
Rate of re-surgery2(3,9)2(15,4)00,232
Mean FU, months7(3-13)10(7-17)12(8,25-15,8)0.256
Hospital mortality3(5,8)000,568

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