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Online ISSN 1827-1847
THE MANAGEMENT OF THORACIC TYPE A DISSECTIONS
Di Bartolomeo R., Pantaleo A., Di Marco L., Savini C., Pacini D., Di Eusanio M.
Cardiovascular Surgery Department, Sant’Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
AIM:The Frozen Elephant Trunk (FET) technique, combining conventional surgery with endovascular techniques, allows patients with extensive diseases of the thoracic aorta to be treated with a hybrid single-stage procedure. This article describes our surgical technique and report on our results after such a procedure.
METHODS: Between January 2007 and February 2011, 96 patients were treated with FET in our Institution. The mean age was 62±10 years. Indication for surgery included: chronic aneurysm (N.=31; 32.3%), acute type A dissection (N.=6; 6.2%), acute type B dissection (N.=2; 2.0%), chronic type A dissection (N.=44; 45.8%), chronic type B dissection (N.=13; 13.5%). Fifty-three patients (55.2%) had undergone one or more previous cardiac/aortic operations. Forty-three associated aortic/cardiac operations were performed. Brain protection was achieved by means of antegrade selective cerebral perfusion and moderate hypothermia (26 °C) in all cases.
RESULTS:Hospital mortality was 14.7%. Postoperatively, major brain complications occurred in 6 patients (6.3%), and paraplegia in 10 (10.4%). Seventeen patients (17.7%) required endovascular completion with a technical/procedural success of 100%.
CONCLUSION: The FET is associated with encouraging early results. As compared to the conventional 2-stage elephant trunk approach, FET seems to offer a greater potential for complete treatment at the prize of a higher rate of post-operative paraplegia. Longer-term follow up are warranted.