title: Simplified frozen elephant trunk repair for acute DeBakey type I dissection.
abstract: OBJECTIVE
  The study objective was to describe a novel technique and assess the safety and feasibility of this initial experience for performing a modified frozen elephant trunk extended repair of acute dissection.
  
  
  METHODS
  From June 2009 to February 2012, 17 patients with DeBakey type I acute aortic dissections underwent emergency surgery using a new approach for extended repair of the ascending arch and proximal descending aorta with a hybrid technique. Fourteen patients were male (82%) with a mean age of 61.4 ± 17.5 years. Some 8 of 17 (47%) presented with malperfusion, and the mean time from symptom onset to operating room was 12.8 ± 3.7 hours. Two patients had root replacement with a stentless bioprosthesis, 1 patient had aortic valve replacement, 13 patients had the valve resuspended, and 1 patient had the native valve reimplanted as a David procedure. A single, commercially available descending thoracic stent graft (26-37 mm TAG, WL Gore and Associates, Flagstaff, Ariz) was delivered antegrade directly into the open descending aorta, trimmed proximally, and sutured into the arch of each patient. The left subclavian artery was covered in 8 of 17 patients (47%). Data were from a prospectively collected database. Follow-up computed tomography was performed at discharge, 3 months, and annually, and assessed with 3-dimensional reconstruction.
  
  
  RESULTS
  There were no perioperative deaths, and all patients are still alive at intermediate follow-up. There were 2 strokes without residual deficit, and 2 patients had paraparesis postoperatively with recovery before discharge. Two patients required temporary tracheostomy for respiratory failure, and 3 patients required temporary hemodialysis. The mean length of stay was 20 ± 12 days, 10 of which were in the intensive care unit. At imaging follow-up, the proximal aortic repair was stable in all patients, and the false lumen was thrombosed in the treated segment in 87.5% of patients.
  
  
  CONCLUSIONS
  A novel simplified frozen elephant trunk hybrid technique for acute type I dissections allows for safe and effective extended aortic repair with false lumen thrombosis and aortic remodeling of the treated segment. Long-term outcomes of this technique warrant further investigation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195-5108, USA. roselle@ccf.org
authors.forename: Eric E
authors.initials: EE
authors.lastname: Roselli
authors.forename: Aldo
authors.initials: A
authors.lastname: Rafael
authors.forename: Edward G
authors.initials: EG
authors.lastname: Soltesz
authors.forename: Leonardo
authors.initials: L
authors.lastname: Canale
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012092:Replantation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome