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Clinical outcomes of the Frozen Elephant Trunk procedure in 70 emergent and elective patients undergoing aortic arch surgery: the Salerno experience with Thoraflex Hybrid
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  • Paolo Masiello,
  • Generoso Mastrogiovanni,
  • Oreste Presutto,
  • Pierpaolo Chivasso,
  • Vito Bruno,
  • Mario Colombino,
  • Mario Miele,
  • Francesco Cafarelli,
  • Rocco Leone,
  • Donato Triggiani,
  • Severino Iesu
Paolo Masiello
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Generoso Mastrogiovanni
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Oreste Presutto
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Pierpaolo Chivasso
Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona'
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Vito Bruno
University of Bristol Medical School
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Mario Colombino
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Mario Miele
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Francesco Cafarelli
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Rocco Leone
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Donato Triggiani
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Severino Iesu
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Abstract

Background and aim of the study. To report early clinical outcomes of the frozen elephant trunk technique (FET) for the treatment of complex aortic diseases after transition from conventional elephant trunk. Methods. A single-center, retrospective study of patients who underwent hybrid aortic arch and FET repair for aortic arch and/or proximal descending aortic aneurysms, acute and chronic Stanford type A aortic dissection with arch and/or proximal descending involvement, Stanford type B acute and chronic aortic dissections with retrograde aortic arch involvement. Results. Between December 2017 and May 2020, 70 consecutive patients (62.7±10.6 years, 59 male) were treated: 41 (58.6%) for acute conditions and 29 (41.4%) for chronic. Technical success was 100%. In-hospital mortality was 14.2% (n=12, 17.1% emergency vs. 10.3% chronic, P=NS); 2 (2.9%) major strokes; 1 (1.4%) spinal cord injury. Follow-up was 12.5 months (IQR 3.7—22.3. Overall survival at 3, 6, 12 and 24 months was 90% (95% CI, 83.2—97.3), 85.6% (95% CI, 77.7—94.3), 79.1% (95% CI, 69.9—89.5), 75.6% (95% CI, 65.8—86.9) and 73.5 (95% CI, 63.3—85.3). There were no aortic re-interventions and no dSINE; 5 patients with residual type B dissection underwent TEVAR completion. Conclusions. In a real-world setting, FET demonstrated a rapid learning curve and good clinical outcomes, even in acute type A aortic dissections. Techniques to perfect the procedure and to reduce remaining risks, and consensus on considerations such as standardized cerebral protection need to be reported.

Peer review status:ACCEPTED

15 Jul 2021Submitted to Journal of Cardiac Surgery
16 Jul 2021Submission Checks Completed
16 Jul 2021Assigned to Editor
16 Jul 2021Reviewer(s) Assigned
09 Aug 2021Review(s) Completed, Editorial Evaluation Pending
09 Aug 2021Editorial Decision: Revise Minor
05 Sep 20211st Revision Received
06 Sep 2021Submission Checks Completed
06 Sep 2021Assigned to Editor
06 Sep 2021Reviewer(s) Assigned
16 Sep 2021Review(s) Completed, Editorial Evaluation Pending
20 Sep 2021Editorial Decision: Accept