ORIGINAL ARTICLE  FRONTIERS IN AORTIC ARCH SURGERY - PART 2 

The Journal of Cardiovascular Surgery 2022 August;63(4):406-14

DOI: 10.23736/S0021-9509.22.12303-7

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Institutional practice in sizing of the hybrid prosthesis in frozen elephant trunk surgery

Idhrees MOHAMMED ¹, Sven Z. TAN ², Matti JUBOURI ³, Matthew SHAW ⁴, Mohamad BASHIR ^{1, 5} ✉

¹ Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Sciences, SIMS Hospital, Chennai, India; ² Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; ³ Hull-York Medical School, University of York, York, UK; ⁴ Research Unit, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK; ⁵ Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales, Cardiff, UK; ⁶ Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

BACKGROUND: The frozen elephant trunk (FET) technique for total arch replacement (TAR) is widely used for repair of aortic arch dissections and aneurysms. Despite its widespread adoption, there are no international or regional guidelines for the sizing of FET prostheses in TAR. We seek to highlight the heterogeneity thereof and pave the way for evidence-based guidelines to advise FET prosthesis sizing in TAR.
METHODS: An online questionnaire was sent to 22 specialist aortic surgeons from 13 different countries across North America, Europe, Asia, and Australia, inquiring about each surgeon’s approach to FET prosthesis sizing. The results were then pooled for frequency analysis.
RESULTS: All 22 surgeons responded to the questionnaire. Zone 2 is preferred implantation zone for AAD, CAD, and TAA (selected by 72.7%, 72.7%, and 68.2% respectively). The maximal diameter of the true lumen in the DTA is the most common index measurement for AAD and CAD (40.9% and 59.1%, respectively). Stent-graft diameters equal to the index measurement is the most common approach for AAD and CAD (77.3% and 45.5%, respectively) while 59.1% of surgeons oversize the index diameter by 10% for TAA; 100 mm is the preferred length for 50.0%, 27.3%, and 40.9% of surgeons in AAD, CAD, and TAA respectively.
CONCLUSIONS: There is considerable heterogeneity in sizing practices for FET prostheses internationally, with variable evidence for its impact on clinical outcomes. This issue would be aided by the development of evidence-based guidelines to inform clinical decision making.

KEY WORDS: Vascular surgical procedures; Blood vessel prosthesis; Aortic arch syndromes; Vascular grafting