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REVIEW  CRITICAL ISSUES ON DEALING WITH CHRONIC POSTDISSECTION ARCH AND THORACOABDOMINAL AORTIC ANEURYSMS 

The Journal of Cardiovascular Surgery 2020 August;61(4):392-401

DOI: 10.23736/S0021-9509.20.11359-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Techniques and outcomes of total aortic arch repair with frozen elephant trunk for DeBakey I dissections

Hidetake KAWAJIRI 1, Mohammad A. KHASAWNEH 2, Alberto POCHETTINO 1, Gustavo S. ODERICH 2

1 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA; 2 Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA



Total aortic arch replacement (TAR) with frozen elephant trunk (FET) technique (FET) has been increasingly used to treat a variety of aortic pathologies over the past two decades. Because FET can effectively treat the diseased arch and cover the proximal entry tear in the distal arch, it is a valuable option in the treatment of DeBakey I aortic dissections. This report focuses on the techniques and outcomes of TAR with FET for acute/chronic aortic dissection. A review of pooled literature including 27 observational studies showed in-hospital mortality, permanent stroke, and spinal cord injury rates of 8.4%, 5.9% and 2.6% for acute aortic dissections, and 7.5%, 4.0% and 4.6% for chronic aortic dissections, respectively. In most of the studies, complete false lumen thrombosis rate was achieved in 80% of patients at the level of FET for acute and chronic aortic dissections. Mid-term outcomes are equally promising. For chronic aortic dissections, positive remodeling of the non-stented distal aortic segments is less frequent leading to secondary reinterventions within 3 to 5 years. However, most studies have not applied distal abdominal extensions of the repair using fenestrated and branched endografts. In the current endovascular era, TAR + FET should be considered as an alternative to conventional open surgical repair in centers of excellence.


KEY WORDS: Aneurysm, dissecting; Vascular surgical procedures; Review

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