Davut ÇEKMECELİOĞLU, Cüneyt KÖKSOY, Joseph COSELLI

Akut DeBakey tip I aort diseksiyonunda frozen elephant trunk tekniğ

Kardiyovasküler cerrahi alanındaki gelişmeler akut DeBakey tip I aort diseksiyonlu hastaların sonuçlarında düzelme sağlamakla birlikte, ameliyat sonrası hastane mortalitesi ve morbiditesi önemini korumaktadır. Frozen elephant trunk tekniği, bu hastalık için bir tedavi seçeneği olup, arkus aort tamiri sırasında proksimal inen torasik aorta uzanacak şekilde tamiri gerçekleştirmek (genellikle median sternotomi ile inen torasik aorta ulaşılamadığı için) ve müteakip rezidüel nativ aort tamirini önlemek, geciktirmek veya kolaylaştırmak için geliştirilmiştir. Bu derlemede, akut DeBakey tip I aort diseksiyonunda frozen elephant trunk rekonstrüksiyonunun kanıtları ve ileriye yönelik gelişmeleri tartışıldı.

The frozen elephant trunk technique in acute DeBakey type I aortic dissection

Although advances in the field of cardiovascular surgery haveimproved outcomes for patients with acute DeBakey type I aorticdissection, postoperative in-hospital mortality and morbidityremain substantial. The frozen elephant trunk technique hasbecome a treatment option for this disease and was developedprimarily to extend repair into the proximal descending thoracicaorta during aortic arch repair (because the descending thoracicaorta is largely inaccessible via median sternotomy), thusavoiding, delaying, or facilitating subsequent repair of residualnative aorta. In this review, we discuss the evidence for andfuture development of frozen elephant trunk reconstruction foracute DeBakey type I aortic dissection.

PDF

___

1. Cambria RP, Brewster DC, Gertler J, Moncure AC, Gusberg R, Tilson MD, et al. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 1988;7:199-209.
2. Crawford ES. The diagnosis and management of aortic dissection. JAMA. 1990;264:2537-41.
3. Fattouch K, Sampognaro R, Navarra E, Caruso M, Pisano C, Coppola G, et al. Long-term results after repair of type a acute aortic dissection according to false lumen patency. Ann Thorac Surg 2009;88:1244-50.
4. Rylski B, Milewski RK, Bavaria JE, Vallabhajosyula P, Moser W, Szeto WY, et al. Long-term results of aggressive hemiarch replacement in 534 patients with type A aortic dissection. J Thorac Cardiovasc Surg 2014;148:2981-5.
5. Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using “elephant trunk” prosthesis. Thorac Cardiovasc Surg 1983;31:37-40.
6. Etz CD, Plestis KA, Kari FA, Luehr M, Bodian CA, Spielvogel D, et al. Staged repair of thoracic and thoracoabdominal aortic aneurysms using the elephant trunk technique: a consecutive series of 215 first stage and 120 complete repairs. Eur J Cardiothorac Surg 2008;34:605-14.
7. LeMaire SA, Carter SA, Coselli JS. The elephant trunk technique for staged repair of complex aneurysms of the entire thoracic aorta. Ann Thorac Surg 2006;81:1561-9.
8. Toda K, Taniguchi K, Masai T, Takahashi T, Kuki S, Sawa Y; Osaka Cardiac Surgery Research (OSCAR) Group. Arch aneurysm repair with long elephant trunk: a 10-year experience in 111 patients. Ann Thorac Surg 2009;88:16-22.
9. Ikeno Y, Yokawa K, Koda Y, Gotake Y, Henmi S, Nakai H, et al. The fate of the downstream aorta after open aortic repair for acute DeBakey type I aortic dissection: total arch replacement with elephant trunk technique versus non-total arch replacement. Eur J Cardiothorac Surg 2019;55:966-74.
10. Inoue Y, Matsuda H, Omura A, Seike Y, Uehara K, Sasaki H, et al. Long-term outcomes of total arch replacement with the non-frozen elephant trunk technique for Stanford Type A acute aortic dissection. Interact Cardiovasc Thorac Surg 2018;27:455-60.
11. Omura A, Miyahara S, Yamanaka K, Sakamoto T, Matsumori M, Okada K, et al. Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement. J Thorac Cardiovasc Surg 2016;151:341-8.
12. Kato M, Ohnishi K, Kaneko M, Ueda T, Kishi D, Mizushima T, et al. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation 1996;94:II188-93.
13. Karck M, Chavan A, Hagl C, Friedrich H, Galanski M, Haverich A. The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms. J Thorac Cardiovasc Surg 2003;125:1550-3.
14. Di Bartolomeo R, Di Marco L, Armaro A, Marsilli D, Leone A, Pilato E, et al. Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis. Eur J Cardiothorac Surg 2009;35:671-5.
15. Preventza O, Cervera R, Cooley DA, Bakaeen FG, Mohamed AS, Cheong BY, et al. Acute type I aortic dissection: traditional versus hybrid repair with antegrade stent delivery to the descending thoracic aorta. J Thorac Cardiovasc Surg 2014;148:119-25.
16. Roselli EE, Loor G, He J, Rafael AE, Rajeswaran J, Houghtaling PL, et al. Distal aortic interventions after repair of ascending dissection: the argument for a more aggressive approach. J Thorac Cardiovasc Surg 2015;149:S117-24.
17. Berger T, Weiss G, Voetsch A, Arnold Z, Kreibich M, Rylski B, et al. Multicentre experience with two frozen elephant trunk prostheses in the treatment of acute aortic dissection†. Eur J Cardiothorac Surg 2019;56:572-8.
18. Jakob H, Dohle D, Benedik J, Jánosi RA, Schlosser T, Wendt D, et al. Long-term experience with the E-vita Open hybrid graft in complex thoracic aortic disease. Eur J Cardiothorac Surg 2017;51:329-38.
19. Shrestha M, Kaufeld T, Beckmann E, Fleissner F, Umminger J, Abd Alhadi F, et al. Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Singlecenter results of the first 100 patients. J Thorac Cardiovasc Surg 2016;152:148-59.
20. Tsagakis K, Jakob H. Which frozen elephant trunk offers the optimal solution? reflections from essen group. Semin Thorac Cardiovasc Surg 2019;31:679-85.
21. Preventza O, Olive JK, Liao JL, Orozco-Sevilla V, Simpson K, Rodriguez MR, et al. Acute type I aortic dissection with or without antegrade stent delivery: Mid-term outcomes. J Thorac Cardiovasc Surg 2019;158:1273-81.
22. Roselli EE, Tong MZ, Bakaeen FG. Frozen elephant trunk for DeBakey type 1 dissection: the Cleveland Clinic technique. Ann Cardiothorac Surg 2016;5:251-5.
23. Preventza O, Liao JL, Olive JK, Simpson K, Critsinelis AC, Price MD, et al. Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients. J Thorac Cardiovasc Surg 2020;160:20-33.
24. Katayama A, Uchida N, Katayama K, Arakawa M, Sueda T. The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience. Eur J Cardiothorac Surg 2015;47:355-60.
25. Leone A, Beckmann E, Martens A, Di Marco L, Pantaleo A, Reggiani LB, et al. Total aortic arch replacement with frozen elephant trunk technique: Results from two European institutes. J Thorac Cardiovasc Surg 2020;159:1201-11.
26. Leontyev S, Tsagakis K, Pacini D, Di Bartolomeo R, Mohr FW, Weiss G, et al. Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: results of a multicentre study. Eur J Cardiothorac Surg 2016;49:660-6.
27. Yamamoto H, Kadohama T, Yamaura G, Tanaka F, Takagi D, Kiryu K, et al. Total arch repair with frozen elephant trunk using the “zone 0 arch repair” strategy for type A acute aortic dissection. J Thorac Cardiovasc Surg 2020;159:36-45.
28. Di Bartolomeo R, Pantaleo A, Berretta P, Murana G, Castrovinci S, Cefarelli M, Folesani G, Di Eusanio M. Frozen elephant trunk surgery in acute aortic dissection. J Thorac Cardiovasc Surg 2015;149:S105-9.
29. Mariscalco G, Bilal H, Catarino P, Hadjinikolaou L, Kuduvalli M, Field M, et al. Reflection from UK aortic group: Frozen elephant trunk technique as optimal solution in type A acute aortic dissection. Semin Thorac Cardiovasc Surg 2019;31:686-90.
30. Takagi H, Umemoto T; ALICE Group. A meta-analysis of total arch replacement with frozen elephant trunk in acute type a aortic dissection. Vasc Endovascular Surg 2016;50:33-46.
31. Inoue Y, Matsuda H, Omura A, Seike Y, Uehara K, Sasaki H, et al. Comparative study of the frozen elephant trunk and classical elephant trunk techniques to supplement total arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg 2019;56:579-86.
32. Ius F, Fleissner F, Pichlmaier M, Karck M, Martens A, Haverich A, et al. Total aortic arch replacement with the frozen elephant trunk technique: 10-year follow-up singlecentre experience. Eur J Cardiothorac Surg 2013;44:949-57.
33. Shrestha M, Martens A, Kaufeld T, Beckmann E, Bertele S, Krueger H, et al. Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years. Eur J Cardiothorac Surg 2017;52:858-66.
34. Evangelista A, Salas A, Ribera A, Ferreira-González I, Cuellar H, Pineda V, et al. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation 2012;125:3133-41.
35. Sakaguchi G, Komiya T, Tamura N, Kimura C, Kobayashi T, Nakamura H, et al. Patency of distal false lumen in acute dissection: extent of resection and prognosis. Interact Cardiovasc Thorac Surg 2007;6:204-7.
36. Akbulut M, Ak A, Arslan Ö, Çekmecelioğlu D, Taş S, Antal Dönmez A, et al. Early and mid-term results of frozen elephant trunk procedure for acute type A aortic dissection. Turk Gogus Kalp Dama 2019;27:135-42.
37. Dohle DS, Tsagakis K, Janosi RA, Benedik J, Kühl H, Penkova L, et al. Aortic remodelling in aortic dissection after frozen elephant trunk. Eur J Cardiothorac Surg 2016;49:111-7.
38. Chen Y, Ma WG, Zhi AH, Lu L, Zheng J, Zhang W, et al. Fate of distal aorta after frozen elephant trunk and total arch replacement for type A aortic dissection in Marfan syndrome. J Thorac Cardiovasc Surg 2019;157:835-49.