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. 2025 Feb 11:30:1-7.
doi: 10.1016/j.xjtc.2025.01.025. eCollection 2025 Apr.

Extra-anatomic left subclavian artery bypass patency in frozen elephant trunk surgery

Leon Mattern  1 , Philipp Pfeiffer  1 , Karen Wittemann  1 , Edoardo Zancanaro  1 , Chris Probst  1 , Ahmed Ghazy  1 , Hendrik Treede  1 , Daniel-Sebastian Dohle  1
Affiliations

Extra-anatomic left subclavian artery bypass patency in frozen elephant trunk surgery

Leon Mattern et al. JTCVS Tech. .

Abstract

Objective: To explore the advantages and consequences of using an extra-anatomic Dacron bypass in frozen elephant trunk surgery for fast and secure left subclavian artery (LSA) reimplantation.

Methods: Between June 2017 and June 2023, 195 patients were treated using an LSA bypass. All postoperative imaging was reviewed to assess the patency of the bypass grafts. If the LSA bypass was not patent, symptoms of complications and their management were evaluated. Time-to-event analysis was performed to assess bypass patency and time to thrombosis.

Results: Out of 195 LSA bypasses, 183 remained patent during follow-up, for a 5-year patency rate of 91.4%. Prolonged cardiopulmonary bypass duration was associated with poorer graft patency. Eight of the 12 patients with a thrombosed LSA bypass were asymptomatic. The most common complication of thrombosed bypass was subclavian steal syndrome. Surgical revision was necessary in 2 of the 4 symptomatic patients. All cases of thrombosed LSA bypass occurred within the first 15 months.

Conclusions: LSA bypass in frozen elephant trunk surgery is a fast and safe technique for supra-aortic artery reimplantation. Bypass thrombosis is rare and often does not require surgical intervention.

Keywords: aortic arch surgery; frozen elephant trunk; ischemic burden; left subclavian artery bypass.

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Conflict of interest statement

Dr Pfeiffer reported receipt of educational grants for the 2022 and 2024 DGTHG Conferences and for the 36th EACTS Annual Meeting in 2022. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Extra-anatomic LSA management in zones 0 and 2.
Figure 1
Figure 1
Overall left subclavian artery bypass (LSAB) patency.
Figure 2
Figure 2
Left subclavian artery bypass (LSAB) patency for different indications for surgery. AAD, Acute aortic dissection; CAD, chronic aortic dissection; TAA, thoracic aortic aneurysm.
Figure 3
Figure 3
Symptoms and treatment of thrombosed left subclavian artery bypass (LSAB). LCCA–LSAB, Left common carotid artery to left subclavian artery bypass.
Figure 4
Figure 4
Survival of patients with patent and thrombosed left subclavian artery bypass (LSAB).
See this image and copyright information in PMC

References

    1. Czerny M., Grabenwöger M., Berger T., et al. EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Ann Thorac Surg. 2024;118:5–115. doi: 10.1016/j.athoracsur.2024.01.021. - DOI - PubMed
    1. Heuts S., Adriaans B.P., Kawczynski M.J., et al. Editor's choice - extending aortic replacement beyond the proximal arch in acute type A aortic dissection: a meta-analysis of short term outcomes and long term actuarial survival. Eur J Vasc Endovasc Surg. 2022;63(5):674–687. doi: 10.1016/j.ejvs.2021.12.045. - DOI - PubMed
    1. Tian D.H., Ha H., Joshi Y., Yan T.D. Long-term outcomes of the frozen elephant trunk procedure: a systematic review. Ann Cardiothorac Surg. 2020;9(3):144–151. - PMC - PubMed
    1. Dohle D.S., Tsagakis K., Janosi R.A., et al. Aortic remodelling in aortic dissection after frozen elephant trunk. Eur J Cardiothorac Surg. 2016;49(1):111–117. doi: 10.1093/ejcts/ezv045. - DOI - PubMed
    1. Detter C., Demal T.J., Bax L., et al. Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases. Eur J Cardiothorac Surg. 2019;56(4):738–745. doi: 10.1093/ejcts/ezz082. - DOI - PubMed

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