Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis

Abstract

Objective: The treatment of complex aortic pathologies of the thoracic aorta remains a challenging issue in aortic surgery. The most recent development of the classic elephant trunk technique, the 'frozen elephant trunk' technique, represents the combination of an endovascular approach with a conventional surgical treatment for a hybrid approach.

Methods: Between January 2007 and July 2008, 34 patients were operated on for complex pathologies of the thoracic aorta using the frozen elephant trunk technique. There were 29 males (85.3%) and the mean age of 61.7+/-9.6 years. The majority of patients (n=18, 52%) presented type A chronic dissection, 7 (21%) patients had chronic aneurysm of distal aortic arch and 7 (21%) type B aortic dissection associated with ascending aorta/aortic arch aneurysm. There were two (6%) cases of acute aortic dissection. Nineteen patients (56%) underwent previous cardiovascular operations.

Results: The overall in-hospital mortality was 6% (two patients). No patient developed postoperative stroke. Ischemic spinal cord injury occurred in three cases (9%) (two paraparesis, one paraplegia). There were five cases (15%) of renal failure (dialysis) and four patients (12%) had pulmonary complications with prolonged mechanical ventilation. Four patients (12%) needed rethoracotomy for surgical bleeding. Six patients (18%) required extension of the descending thoracic aorta repair with endovascular treatment for persistent perfusion of the dilated false lumen.

Conclusions: The frozen elephant trunk technique with the new E-vita open prosthesis combines surgical and interventional technologies and represents a feasible and efficient option in the treatment of complex aortic pathologies. Strict monitoring of the patient has to be carried out in order to detect possible evolution of the aortic lesion, which can require prompt treatment. However, long-term follow-up is required.