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. 2020 May;9(3):178-188.
doi: 10.21037/acs-2020-fet-25.

Results of frozen elephant trunk from the international E-vita Open registry

Konstantinos Tsagakis  1 , Davide Pacini  2 , Martin Grabenwöger  3 , Michael A Borger  4 , Nora Goebel  5 , Wolfgang Hemmer  6 , Alvaro Laranjeira Santos  7 , Thanos Sioris  8 , Kazimierz Widenka  9 , Petar Risteski  10 , Jorge Mascaro  11 , Igor Rudez  12 , Andreas Zierer  13 , Carlos A Mestres  14   15 , Arjang Ruhparwar  1 , Roberto Di Bartolomeo  2 , Heinz Jakob  1
Affiliations

Results of frozen elephant trunk from the international E-vita Open registry

Konstantinos Tsagakis et al. Ann Cardiothorac Surg. 2020 May.

Abstract

Background: Over the years, frozen elephant trunk (FET) has become the treatment of choice for multisegmental thoracic aortic disease. This multicenter study presents the evolution of FET results using the E-vita Open hybrid graft with respect to institutional experience and time.

Methods: The data of International E-vita Open registry were studied according to the institutional experience of the participating centers (high- versus low-volume centers) and according to the evolution of FET treatment during time (1st period, 2005-2011 versus 2nd period, 2012-2018). Overall, 1,165 patients were enrolled in the study with a wide variety of multisegmental thoracic aortic pathologies and aortic emergencies. Participating centers determined their own surgical protocol.

Results: The overall 30-day mortality was 12%. Short- and long-term survival were higher in high- versus low-volume centers (P=0.048 and P=0.013, respectively). In the 2nd time period, cerebral complications were reduced significantly (P=0.015). Incidence of permanent spinal cord-related symptoms was reduced to 3% in the 2nd time period, but did not reach statistical significance. Hypothermic circulatory arrest time (P<0.001) and incidence of postoperative temporary renal replacement therapy (P=0.008) were significantly reduced in the 2nd time period. Ten-year survival and freedom from aortic-related death rates were 46.6% and 85.7%, respectively, for the entire group. The freedom from distal aortic re-interventions for a new or progressive residual aortic disease was 76.0%.

Conclusions: Evolution of FET arch repair techniques with the E-vita Open graft and increasing institutional experience were associated with improved results. Progression of residual aortic disease makes close follow-up with aortic imaging mandatory in such patients.

Keywords: Frozen elephant trunk (FET); aortic aneurysm; aortic arch; aortic dissection.

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Conflict of interest statement

Conflicts of Interest: HJ was the consultant to Jotec GmbH during the study period. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis for overall cumulative survival (A), freedom from aortic related death (B) and freedom from proximal and distal aortic re-interventions (C); the freedom from aortic re-interventions along the descending aorta distal to the graft is presented separately in (D).
Figure 2
Figure 2
Cumulative survival and freedom from re-interventions at 6 years follow-up between the high- versus low-volume centers (A,C) and between the 1st and 2nd period of the study (B,D); the freedom from re-interventions along the descending aorta distal to the graft is presented separately in (E,F), respectively.
See this image and copyright information in PMC

References

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