Aortic arch replacement using the frozen

elephant trunk technique

F. Beyersdorf

Type of surgery Volume

Root/ ascending 124

Ascending/ hemiarch 19

Total arch (including FET) 35

TEVAR 43

EVAR 56

AAA classical surgery 87

TAAA classical surgery 17

Other 14

Total 395

The aortic programme 2015

UHZ Freiburg • Bad Krozingen

Czerny et al., EJCTS in press

Frozen Elephant Trunk Devices

• Gianturco Z-Stent (Cook, Inc.)

• Chavan-Haverich Prothesis (Curative GmbH)

• E-Vita open and E-Vita open Plus (Jotec GmbH)

• Cronus (Micro Post Medical Co.)

• Thoraflex Hybrid Prothesis (Vascutec, Terumo)

Thoraflex hybrid

Underlying diagnoses

• Acute type A aortic dissection

• Remaining type B after type A repair

• Aneurysmal formation- megaaortic syndrome

• Penetrating atherosclerotic ulcers

• Acute type B aortic dissection

Class of recommendation IIa

Level of evidence C

Acute type A aortic dissection-

distal entry/malperfusion

/

Preoperative CT scan

/

/

Postperative CT scan

Class of recommendation IIb

Level of evidence C

Acute type A aortic dissection-

aneurysm formation

Aneurysm of remaining type B

after previous type A repair

Evolving concept

/

Preoperative CT scan

/

Postoperative CT scan

Megaaortic syndrome

Class of recommendation IIa

Level of evidence C

Distal extension

Multiple penetrating atherosclerotic ulcers affecting

the entire thoracic aorta

Evolving concept

/

Preoperative CT scan

/

/

Postoperative CT scan

Complicated acute type B aortic dissection without a landing

zone for TEVAR, due to an ectatic aortic arch

Class of recommendation IIa

Level of evidence C

The Freiburg Experience:

FET – Aortic pathologies

FET-Implantation Freiburg Year

Aortic pathology 2015 2016

Dissection 21 20

Type A acute, n (%) 4 (19) 7 (35)

Type A chronic, n (%) 8 (38) 7 (35)

Type B acute, n (%) 4 (19) 2 (10)

Type B chronic, n (%) 2 (10) 0 (0)

Non-A-non-B acute, n (%) 1 (5) 2 (10)

Non-A-non-B chronic, n (%) 2 (10) 2 (10)

Aneurysm 8 12

Acute, n (%) 0 (0) 0 (0)

Chronic, n (%) 8 (100) 12 (100)

PAU (isolated) 0 1

Acute, n (%) 0 (0) 0 (0)

Chronic, n (%) 0 (0) 1 (100)

Total 29 33

Lowest body temperature, ± SD, °C 24.2±2.1

Operative times

CBP, ± SD, min 224±52

CX, ± SD, min 127±50

HCA, ± SD, min 48±32

SAP, ± SD, min 76±33

Concomitant procedures

Bentall, No. (%) 7 (11)

Valve sparing root, No. (%) 6 (10)

AVR, No. (%) 9 (15)

CABG, No. (%) 8 (13)

Other, No. (%) 4 (6)

Rethoracotomy, No. (%) 11 (18)

Disabling stroke, No. (%) 7 (11)

Paraplegia, No. (%) 0 (0)

Recurrent nerve palsy, No. (%) 3 (5)

Tracheotomy, No. (%) 4 (6)

Dialysis, No. (%) 8 (13)

ICU/IMC stay, ± SD, d 9.1±8.3

Hospital stay, ± SD, d 20.9±14.3

The Freiburg Experience:

FET – Operative Details

Outcome

Mean follow up, ± SD, m 9.73 ± 10.1

Survival, No. (%) 56 (90)

In hospital mortality, No. (%) 3 (5)

Mortality during follow up, No. (%) 3 (5)

Aortic reinterventions, No. (%) 9 (15)

TEVAR, No. (%) 8 (13)

Surgical thoracoabdominal aortic

replacement, No. (%)

1 (2)

The Freiburg Experience:

FET - Outcome

Summary

• FET broadenes indications and simplifies treatment

• The concept of obtaining most complete primary repair is

effective and facilitates secondary intervention

• Rate of symptomatic spinal cord ischemia may be

reduced by using the short stent-graft version

• A standardized approach makes the procedure safe and

reproducable