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DOI: 10.1055/s-0035-1544566
“Frozen” Elephant Technique: First Experience with the Vascutek Thora-flex Hybrid Prosthesis - A Single Center Perspective
Introduction: A modern concept for the treatment of extended aortic disease involving the aortic arch and the proximal descending aorta in acute and chronic cases is the frozen elephant technique. One challenging aspect of this extensive arch surgery is the reimplantation of the supra aortic vessels. We report our experience with the novel 4-branched hybrid graft, the Vascutek ThoraflexTM hybrid graft (Vascutek, Scotland) for frozen elephant trunk (FET) surgery to treat patients with extensive diseases of the thoracic aorta.
Methods: Between April 2013 and August 2014 22 consecutive patients (male 68.2%, 63.3 ± 11.6 years) were operated using Vascutek Thora-flex hybrid prosthesis for frozen elephant trunk surgery. Mean euroscore II was 12.5 ± 14.4. Indications for surgery were as followed: degenerative/ arteriosclerotic aneurysm (36.4%, n = 8), Debakey 1 (45.5%, n = 10) and 3 (18.2%, n = 4) dissections. 7 patients were operated as emergencies with acute type A aortic dissection. 2 patients were diagnosed with Marfan-syndrome. About one quarter of the patients had previous cardiac surgery (22.8%, n = 5). The stentgraft (length 10cm) was deployed using deep hypothermic (< 25°C) circulatory arrest and selective antegrade cerebral perfusion controlled by NIRS.
Results: 30-day mortality was 18.2% (n = 4). Temporary and permanent neurological deficit occurred in 13.6% (n = 3) and 9.5% (n = 2) respectively, paraplegia in 5% (n = 1). Aortic root replacement was performed in 9 patients (7 Bentall, 31.8% and 2 David procedures 9.1%). The times for bypass, aortic clamping, selective cerebral perfusion and circulatory arrest were 295 ± 87, 146 ± 83, 93 ± 44, and 84 ± 40 minute respectively.
Conclusion: The 4-branched hybrid graft allows surgical reconstruction for extended aortic pathologies. This concept involving the 4 branches allows for a reduced circulatory arrest time as compared with the cerebral perfusion time which results in a low rate of spinal ischemia and is associated with an acceptable incidence of cerebrovascular events.