title: [Extensive disease of the thoracic aorta: hybrid treatment with the frozen elephant trunk technique].
abstract: BACKGROUND
  Aneurysms of the aortic arch extending beyond the origin of the left subclavian artery represent a challenging pathology in aortic surgery and, most commonly, are treated with different surgical, endovascular or hybrid two-staged procedures. In 2006, we initiated an intense surgical program with the frozen elephant trunk procedure that, combining together conventional surgery with endovascular techniques, allows single-stage treatment of patients with extended disease of the thoracic aorta. We here describe our surgical technique and the results with the single-stage frozen elephant trunk procedure.
  
  
  METHODS
  Between January 2007 and August 2010, 87 patients were treated with the frozen elephant trunk procedure in our institution. The mean age was 62 ± 10 years. Indications for surgery included: chronic aneurysm (n=28; 32.2%), acute type A dissection (n=5; 5.7%), acute type B dissection (n=2; 2.3%), chronic type A dissection (n=41; 47.2%), chronic type B dissection (n=11; 12.6%). Forty-nine patients (56.4%) had undergone previous cardiac/aortic operations. Sixty-four associated aortic/cardiac operations were performed.
  
  
  RESULTS
  Hospital mortality was 12.6%. Postoperatively, major neurological complications occurred in 4 patients (4.5%) and paraplegia in 6 (6.9%). Follow-up was 100% completed at a mean time of 15.0 ± 12.4 months. Estimated 3-year survival was 72.7 ± 8.3%. Endovascular extension was required in 14 patients (16.0%) with a technical/procedural success of 100%.
  
  
  CONCLUSIONS
  Our preliminary results with the frozen elephant trunk in the above-mentioned high-risk group of patients were encouraging. The frozen elephant trunk, as a single-stage hybrid procedure, avoids peculiar drawbacks of staged procedures such as cumulative mortality of two major aortic procedures, interval mortality and failure to complete the final stage.
authors.affiliation: Dipartmento di Cardiochirurgia, Ospedale S. Orsola-Malpighi, Università Degli Studi, Bologna. marco.dieusanio2@unibo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armaro
authors.forename: Luca
authors.initials: L
authors.lastname: Di Marco
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.forename: Antonio
authors.initials: A
authors.lastname: Pantaleo
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
mesh_terms: D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014656:Vascular Surgical Procedures