Beckmann Erik, Martens Andreas, Korte Wilhelm, Kaufeld Tim, Krueger Heike, Haverich Axel, Shrestha Malakh
Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Ann Cardiothorac Surg. 2020 May;9(3):170-177. doi: 10.21037/acs.2020.03.09.
The frozen elephant trunk (FET) technique was introduced in Hannover Medical School in 2001 to treat patients with complex aortic arch pathologies. Since 2012, we primarily use the trifurcated Thoraflex Hybrid FET graft. In this article, we report our experience with the trifurcated FET graft.
Between November 2012 and September 2018, 211 patients underwent FET implantation with the trifurcated Vascutek Thoraflex Hybrid graft. The indications for surgery were: degenerative aneurysms in 68 patients, acute aortic dissections (AD) in 96 patients, and chronic ADs in 47 patients. And, 18% of cases were sternal re-operations.
Mean cardiopulmonary bypass time, aortic cross-clamp time, and myocardial ischemia time were 262±84, 115±71, 50±26 minutes, respectively. Incidence of re-thoracotomy for bleeding, stroke, permanent paraplegia/paraparesis, prolonged ventilatory support (>96 h), and long-term dialysis were 13%, 18%, 2%, 21%, and 5%, respectively. In-hospital mortality was 12%. Follow-up was complete for 100% of patients and comprised a total of 513 patient years. The mean follow-up time was 2.2 [0-6] years. During follow-up, there were 32 aortic re-interventions distal to the FET. The survival rate at 1 and 5 years was 84% and 81%, respectively.
Total aortic arch replacements with trifurcated FET can be performed with positive results. The trifurcated graft allows selective anastomosis of the supra-aortic vessels, which might result in improved hemostasis.
2001年汉诺威医学院引入了“冰冻象鼻”（FET）技术，用于治疗复杂主动脉弓病变患者。自2012年以来，我们主要使用三分支Thoraflex Hybrid FET移植物。在本文中，我们报告了使用三分支FET移植物的经验。
2012年11月至2018年9月期间，211例患者接受了三分支Vascutek Thoraflex Hybrid移植物的FET植入术。手术适应症为：68例退行性动脉瘤、96例急性主动脉夹层（AD）和47例慢性AD。此外，18%的病例为胸骨再次手术。
平均体外循环时间、主动脉阻断时间和心肌缺血时间分别为262±84、115±71和50±26分钟。因出血、中风、永久性截瘫/轻瘫、延长通气支持（>96小时）和长期透析而再次开胸手术的发生率分别为13%、18%、2%、21%和5%。住院死亡率为12%。100%的患者完成了随访，总计513患者年。平均随访时间为2.2[0 - 6]年。随访期间，FET远端有32次主动脉再次干预。1年和5年生存率分别为84%和81%。
使用三分支FET进行全主动脉弓置换术可取得积极效果。三分支移植物允许选择性吻合主动脉弓上血管，这可能会改善止血效果。
