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Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections

Background  Acute Type A aortic dissection (AAAD) is a surgical emergency. In patients with arch and descending aorta involvement (DeBakey Type I), a total aortic arch replacement with frozen elephant trunk (FET) could favor false lumen thrombosis and improve long-term results. The authors hereby pr...

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Autores principales: López Almodóvar, Luis F., Lima Cañadas, Pedro, Enríquez Puga, Andrés, Narváez Mayorga, Irene, Buendía Miñano, José A., Sánchez Casado, Marcelino, Cañas Cañas, Alfonso
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Thieme Medical Publishers 2019
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482024/
https://www.ncbi.nlm.nih.gov/pubmed/31018235
http://dx.doi.org/10.1055/s-0039-1677809
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author López Almodóvar, Luis F.
Lima Cañadas, Pedro
Enríquez Puga, Andrés
Narváez Mayorga, Irene
Buendía Miñano, José A.
Sánchez Casado, Marcelino
Cañas Cañas, Alfonso
author_facet López Almodóvar, Luis F.
Lima Cañadas, Pedro
Enríquez Puga, Andrés
Narváez Mayorga, Irene
Buendía Miñano, José A.
Sánchez Casado, Marcelino
Cañas Cañas, Alfonso
author_sort López Almodóvar, Luis F.
collection PubMed
description Background  Acute Type A aortic dissection (AAAD) is a surgical emergency. In patients with arch and descending aorta involvement (DeBakey Type I), a total aortic arch replacement with frozen elephant trunk (FET) could favor false lumen thrombosis and improve long-term results. The authors hereby present their experience with this technique in a single low-volume center, to assess whether the technique is feasible to treat such disease. Methods  From January 2011 to December 2016, 43 patients with AAAD were operated on in the authors' institution, which carries out 300 to 350 annual procedures. Among these, 12 patients with an intimal tear in the aortic arch and/or proximal descending aorta received a FET procedure (10 males, age 57 years). Concomitant procedures were aortic valve replacement (42%), Bentall (25%), and aortic valve repair (17%). Results  Cardiopulmonary bypass, cardiac arrest, and circulatory arrest times were 235 ± 43, 171 ± 33, and 75 ± 20 minutes, respectively. The operative mortality was 16.7% ( n  = 2). Stroke and re-thoracotomy for bleeding occurred in 8% ( n  = 1) and 8% ( n  = 1), respectively. There was no spinal cord injury. Follow-up was 36.1 months. During follow-up, no patients died or required a reoperation on the downstream aorta. Conclusion  Although all patients were operated on in a low-volume center, the results with FET in AAAD are acceptable. Even though this technique demands high technical skills, it is a promising approach in patients with acute aortic dissection.
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spelling pubmed-64820242019-04-25 Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections López Almodóvar, Luis F. Lima Cañadas, Pedro Enríquez Puga, Andrés Narváez Mayorga, Irene Buendía Miñano, José A. Sánchez Casado, Marcelino Cañas Cañas, Alfonso Aorta (Stamford) Background  Acute Type A aortic dissection (AAAD) is a surgical emergency. In patients with arch and descending aorta involvement (DeBakey Type I), a total aortic arch replacement with frozen elephant trunk (FET) could favor false lumen thrombosis and improve long-term results. The authors hereby present their experience with this technique in a single low-volume center, to assess whether the technique is feasible to treat such disease. Methods  From January 2011 to December 2016, 43 patients with AAAD were operated on in the authors' institution, which carries out 300 to 350 annual procedures. Among these, 12 patients with an intimal tear in the aortic arch and/or proximal descending aorta received a FET procedure (10 males, age 57 years). Concomitant procedures were aortic valve replacement (42%), Bentall (25%), and aortic valve repair (17%). Results  Cardiopulmonary bypass, cardiac arrest, and circulatory arrest times were 235 ± 43, 171 ± 33, and 75 ± 20 minutes, respectively. The operative mortality was 16.7% ( n  = 2). Stroke and re-thoracotomy for bleeding occurred in 8% ( n  = 1) and 8% ( n  = 1), respectively. There was no spinal cord injury. Follow-up was 36.1 months. During follow-up, no patients died or required a reoperation on the downstream aorta. Conclusion  Although all patients were operated on in a low-volume center, the results with FET in AAAD are acceptable. Even though this technique demands high technical skills, it is a promising approach in patients with acute aortic dissection. Thieme Medical Publishers 2019-04-24 /pmc/articles/PMC6482024/ /pubmed/31018235 http://dx.doi.org/10.1055/s-0039-1677809 Text en https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle López Almodóvar, Luis F.
Lima Cañadas, Pedro
Enríquez Puga, Andrés
Narváez Mayorga, Irene
Buendía Miñano, José A.
Sánchez Casado, Marcelino
Cañas Cañas, Alfonso
Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections
title Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections
title_full Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections
title_fullStr Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections
title_full_unstemmed Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections
title_short Single Low-Volume Center Experience with Frozen Elephant Trunk in Acute Type A Aortic Dissections
title_sort single low-volume center experience with frozen elephant trunk in acute type a aortic dissections
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482024/
https://www.ncbi.nlm.nih.gov/pubmed/31018235
http://dx.doi.org/10.1055/s-0039-1677809
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