Hybrid arch frozen elephant trunk repair: evidence from the Canadian Thoracic Aortic Collaborative

Maral Ouzounian; Ali Hage; Jennifer Chung; Louis-Mathieu Stevens; Ismail El-Hamamsy; Vincent Chauvette; Francois Dagenais; Andreanne Cartier; Mark Peterson; Alana Harrington; Munir Boodhwani; Ming Guo; John Bozinovski; Stephanie Fox; Linrui Guo; Michael W A Chu; Canadian Thoracic Aortic Collaborative

doi:10.21037/acs-2020-fet-22

Hybrid arch frozen elephant trunk repair: evidence from the Canadian Thoracic Aortic Collaborative

Ann Cardiothorac Surg. 2020 May;9(3):189-196. doi: 10.21037/acs-2020-fet-22.

Authors

Maral Ouzounian¹, Ali Hage², Jennifer Chung¹, Louis-Mathieu Stevens³, Ismail El-Hamamsy⁴, Vincent Chauvette³, Francois Dagenais⁵, Andreanne Cartier⁵, Mark Peterson¹, Alana Harrington¹, Munir Boodhwani⁶, Ming Guo⁶, John Bozinovski⁷, Stephanie Fox², Linrui Guo², Michael W A Chu²; Canadian Thoracic Aortic Collaborative

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
² Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada.
³ Division of Cardiac Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada.
⁴ Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicjne at Mount Sinai, New York, NY, USA.
⁵ Division of Cardiac Surgery, Department of Surgery, Laval University, Quebec City, QC, Canada.
⁶ Division of Cardiac Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
⁷ Division of Cardiac Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA.

Abstract

Background: The frozen elephant trunk (FET) technique has become an increasingly popular strategy for aortic reconstruction in the setting of extensive thoracic aortic aneurysms or dissections. The objective of this study is to report on the Canadian experience with the FET technique in both the elective and emergent settings.

Methods: A total of 167 consecutive patients (mean age 65±13 years, 30% female, 25% re-operation) underwent elective (70%) and non-elective (30%) aortic arch reconstruction with the FET technique between May 2008 and October 2019 in six centers of the Canadian Thoracic Aortic Collaborative (CTAC). In-hospital clinical endpoints and early imaging endpoints were prospectively collected and analyzed.

Results: All 167 patients underwent successful FET implantation. In-hospital mortality occurred in 14 patients (8%), stroke occurred in 22 patients (13%) and temporary and permanent spinal cord ischemia (SCI) occurred in 6 (3.6%) and 3 (1.8%) patients, respectively. Prolonged mechanical ventilation was required in 35 patients (21%), renal failure requiring dialysis in 14 patients (8%) and atrial fibrillation in 59 patients (36%). The median hospital and intensive care unit (ICU) lengths of stay were 3 [interquartile range (IQR): 1, 6] and 10 (IQR: 7, 17) days, respectively. The rate of type 1A endoleak was 3.6%, with the lowest rate in patients who underwent a total arch replacement with a hybrid FET graft (0%) and the highest among patients who had a hemiarch with antegrade thoracic endovascular aortic repair (TEVAR) deployment (25%). The rate of other types of endoleak and stent complications was comparatively low.

Conclusions: The early CTAC experience with the FET operation demonstrates technical feasibility and good early clinical outcomes in elective and emergent patients. Further analysis is required to explore variations in technique and their potential impact on early and late outcomes.

Keywords: Hybrid arch repair; aortic arch; frozen elephant trunk (FET).