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. 2021 Jun 14;59(6):1247-1254.
doi: 10.1093/ejcts/ezaa486.

Taking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study

Martin Grabenwöger  1   2   3 , Markus Mach  4 , Heinrich Mächler  5 , Zsuzsanna Arnold  1   3 , Harald Pisarik  1   3 , Sandra Folkmann  1   3 , Marie-Luise Harrer  1   3 , Daniela Geisler  1   3 , Reinhard Moidl  1   3 , Bernhard Winkler  1   2   3 , Johannes Bonatti  1   3 , Martin Czerny  6 , Gabriel Weiss  2   7
Affiliations

Taking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study

Martin Grabenwöger et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: Our goal was to develop a modified frozen elephant trunk (FET) prosthesis with a stented left subclavian artery (LSA) side branch for LSA connection and to perform preclinical testing in a human cadaver model.

Methods: We measured aortic diameters, distance between and diameters of supra-aortic vessels and the distance from the LSA offspring to the level of the left vertebral artery offspring in 70 patients. Based on these measurements, a novel FET prosthesis was developed (Cryolife/Jotec, Hechingen, Germany) featuring a stented side branch for an intrathoracic LSA connection. The feasibility and ease of implantation were tested in 2 human cadaver models at the Anatomical Institute of the Medical University Graz. A covered stent graft (Advanta V12™ by Atrium Medical Corp., Hudson, NH, USA) was used for an LSA extension.

Results: Accurate deployment of the novel FET prosthesis with anatomical orientation of the stented side branch towards the LSA ostium followed by consecutive stent graft deployment was feasible in both cases. Proximalizing the distal anastomosis level from zone 3 to zone 1 not only diminished the complexity of the procedure but substantially facilitated the completion of the distal anastomosis. A 2.5-cm long extension stent graft was sufficient to seal to the LSA and to maintain left vertebral artery patency in both cases.

Conclusions: This initial study in human anatomical bodies could demonstrate the feasibility of implanting a newly designed FET prosthesis. This evolution of the FET technique has the potential to substantially ease total aortic arch replacement by proximalization of the distal anastomosis into zone 1 and by shortening spinal and lower body hypothermic circulatory arrest times via a stented side branch to the LSA. This direct connection enables early restoration of systemic perfusion.

Keywords: Anatomy of the aortic arch; Frozen elephant trunk technique; Left subclavian artery side branch stent graft; Total aortic arch replacement.

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Figures

Figure 1:
Figure 1:
Points at which measurements were taken for conceptualization of a frozen elephant trunk prosthesis with a stented side-branch for the left subclavian artery.
Figure 2:
Figure 2:
Frozen elephant trunk prosthesis with a stented side-branch for the LSA prosthesis showing the LSA side branch stent. LCC: left common carotid; LSA: left subclavian artery.
Figure 3:
Figure 3:
Short introduction and deployment device for the novel prosthesis.
Figure 4:
Figure 4:
View during implantation showing exact orientation of the side branch towards the LSA ostium. LSA: left subclavian artery.
Figure 5:
Figure 5:
Distal anastomosis is performed in zone 1 of the aortic arch.
Figure 6:
Figure 6:
Intraprocedural completion angiography showing no endoleak at the level of the left subclavian artery and regular antegrade perfusion of the left vertebral artery.
None
See this image and copyright information in PMC

Comment in

  • The goal of simplifying complex aortic arch surgery.
    Detter C, Brickwedel J. Detter C, et al. Eur J Cardiothorac Surg. 2021 Jun 14;59(6):1254-1255. doi: 10.1093/ejcts/ezab075. Eur J Cardiothorac Surg. 2021. PMID: 33582754 No abstract available.
  • Reply to Maze and Tokui.
    Grabenwöger M, Weiss G. Grabenwöger M, et al. Eur J Cardiothorac Surg. 2022 Jul 11;62(2):ezab486. doi: 10.1093/ejcts/ezab486. Eur J Cardiothorac Surg. 2022. PMID: 34964476 No abstract available.

References

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