ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2023 December;64(6):668-77

DOI: 10.23736/S0021-9509.23.12706-6

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Frozen elephant trunk technique for aortic arch surgery: the Bordeaux University Hospital experience with Thoraflex hybrid prosthesis

Besart CUKO ¹ ✉, Mathieu PERNOT ¹, Olivier BUSUTTIL ¹, Massimo BAUDO ², Fabrizio ROSATI ², Saud TAYMOOR ¹, Thomas MODINE ¹, Louis LABROUSSE ¹

¹ Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, University Hospital of Bordeaux, Bordeaux, France; ² Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy

BACKGROUND: Aortic arch surgery still represents a challenge, and the frozen elephant trunk (FET) allows a one-step surgery for complex aortic diseases. The aim of the study was to analyze the results of patients undergoing FET procedure for aortic arch surgery at Bordeaux University Hospital.
METHODS: Patients undergoing FET procedure for multisegmented aortic arch pathologies were analyzed in this single-center retrospective study. Further subgroup analyses were performed according to the degree of urgency of the operation (elective versus emergent surgery) and cerebral protection technique: bilateral selective antegrade cerebral perfusion (B-SACP) versus the unilateral one (U-SACP), regardless of the degree of urgency.
RESULTS: From August 2018 to August 2022, 77 consecutive patients (64.1±9.9 years, 54 males) were enrolled: 43 (55.8%) for elective surgery and 34 (44.2%) in emergency. Technical success was 100%. 30-day mortality was 15.6% (N.=12, 7% elective vs. 26.5% emergent, P=0.043). Six (7.8%) non-disabling strokes occurred (1.9% B-SACP vs. 20% U-SACP, P=0.021). Median follow-up was 1.11 years (interquartile range, 0.62-2.07). The 1-year overall survival was 81.6±4.45%. The elective group showed a survival trend when compared to the emergency one (P=0.054). However, further examination at landmark analysis elective surgery showed a better survival trend compared to emergency surgery up to 1.78 years (P=0.034), after which significance was lost (P=0.521).
CONCLUSIONS: Thoraflex hybrid prosthesis for FET technique demonstrated feasibility and satisfactory short-term clinical outcomes, even in emergent settings. In our practice B-SACP seems to offer better protection and less neurological complications compared to U-SACP, nevertheless further analyses are warranted.

KEY WORDS: Surgery; Aortic arch syndromes; Prostheses and implants