The Stent Is Not to Blame: Lessons Learned With a Simplified US Version of the Frozen Elephant Trunk

Ourania Preventza, Joseph S. Coselli, Jessica Mayor, Katherine Simpson, Julius Carillo, Matt D. Price, Lorraine D. Cornwell, Shuab Omer, Kim I. de la Cruz, Faisal G. Bakaeen, Arin Jobe

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Background We analyzed trends, assessed outcomes and lessons learned, and investigated whether using a simplified US version of the frozen elephant trunk (FET) technique to treat complex arch pathology poses additional risk. Methods From 2010 to 2015, we performed 129 consecutive ET procedures (traditional ET [t-ET], n = 92 [71.3%]; FET, n = 37 [28.7%]) for chronic dissecting (n = 62 [48.1%]) and atherosclerotic aneurysms (n = 67 [51.9%]). A stepwise logistic regression model using preoperative and intraoperative variables was created to analyze the outcomes. Results Thirty-day mortality was 12.4% (t-ET, n = 9 [9.8%]; FET, n = 7 [18.9%]; p = 0.24). The rate of persistent (at the time of discharge) stroke was 5.4% (t-ET, n = 5 [5.4%]; FET, n = 2 [5.4%]; p =1.00). The rate of persistent spinal cord deficit was 3.9% (t-ET, n = 3 [3.3%]; FET, n = 2 [5.4%]; p = 0.62). In the multivariable analyses, the addition of FET was not an independent predictor of mortality, permanent stroke, or spinal cord deficit. Conclusions With the advent of endovascular technology, there is a clinical shift toward increased use of FET to eliminate or facilitate the second surgical stage in treating patients with extensive aortic pathology. The addition of FET to the surgical armamentarium does not seem to pose additional risk (although larger studies are needed), but judicious use is advised nonetheless. A single-piece endoprosthesis for FET instead of a customized one should be considered.

Original languageEnglish (US)
Pages (from-to)1456-1463
Number of pages8
JournalAnnals of Thoracic Surgery
Volume104
Issue number5
DOIs
StatePublished - Nov 2017
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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