Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Frontiers in Cardiovascular Medicine

article

Matti Jubouri¹  Fatima Kayali²  Priyanshu Saha³  Daniyal M. Ansari³  Yousef Rezaei⁴  Sven Z. C. P. Tan⁵  Mostafa Mousavizadeh⁴  Saeid Hosseini⁴  Idhrees Mohammed⁶  Mohamad Bashir⁷ 

[1] Hull York Medical School, University of York;School of Medicine, University of Central Lancashire;School of Medicine, St George's University of London;Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences;Barts and The London School of Medicine and Dentistry, Queen Mary University;Institute of Cardiac and Aortic Disorders ,(ICAD), SRM Institutes for Medical Science ,(SIMS Hospital);Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales

关键词: aortic dissection;    aortic aneurysm;    aortic surgery;    frozen elephant trunk;    total arch replacement;   

DOI  :  10.3389/fcvm.2022.875078

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background: The introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortivascular surgery by allowing hybrid repair of complex aortic pathologies in a single step through combining an open surgical approach with an endovascular one. FET has been associated with favorable aortic remodeling, however, its is also associated with development of distal stent graft induced new entry (dSINE) tears postoperatively. The rate of aortic remodeling and the incidence of dSINE have been linked together, in addition, there seems to be a relationship between these two variables and FET insetion length as well as graft size. Aims: The scope of this review is to highlight the rate of aortic remodeling as well the incidence of dSINE associated with different FET devices available commercially. This review also aimed to investigate the relationship between aortic remodeling, dSINE, FET insertion length and FET graft size. Methods: We conducted a comprehensive literature search using multiple electronic databases including PubMed, Ovid, Scopus and Embase in order to collate all research evidence on the above mentioned variables. Results: ThoraflexTM Hybrid Plexus seems to yield optimum aortic remodeling by promoting maximum false thrombosis as well true lumen expansion. Thoraflex HybridTM is also associated with the lowest incidence of dSINE post-FET relative to the other FET devices on the market. Aortic remodeling and dSINE do influence each other and are both linked with FET graft length and size. Conclusion: The FET technique for TAR shows excellent aortic remodeling but is associated with a considerable risk of dSINE development. However, ThoraflexTM Hybrid has demonstrated itself to be the superior FET device on the aortic arch prostheses market. Since aortic remodeling, dSINE, FET insertion length and stent graft size are all interconnect, the choice of FET device length and size must be made with great care for optimum results.

【 授权许可】

CC BY