Combined frozen elephant trunk and endovascular repair for extensive thoracic aortic aneurysms.
BACKGROUND
We describe a 1-step treatment of extensive arch and descending aortic aneurysm by combination of frozen elephant trunk (FET) (hybrid endoprosthesis) and of conventional endoprosthesis deployment.


METHODS
In a single-center, prospective, treatment-only study, the clinical data of 4 patients receiving combined FET and distal endoprosthesis deployment in the descending aorta were prospectively collected. Thoracic endoprostheses were deployed either retrogradely (off-pump from the femoral arterial access) or antegradely (from the aortic arch during hypothermic arrest). A distal-first approach was used ("trombone" mechanism). Spinal cord protection was achieved by transposition of the left subclavian artery to the left common carotid artery and selective antegrade cerebral perfusion. Preoperative computed tomography scan was performed to identify the collateral circulation. Preoperative planning was assisted by a sizing software (Endosize, Therenva Inc.).


RESULTS
The aortic coverage was extended down to the orifice of the celiac trunk in one case and to the T8 level in the remainders. There was no operative mortality, 1 transient paraparesis, and 1 case of renal insufficiency. Follow-up results were satisfying (no device migration, no endoleak, no endotension, and no late neurologic complications).


CONCLUSIONS
The present strategy may abolish the risks connected with the waiting time between the surgical first step and the later completion (aortic-related adverse events and drop-out) and deserves further investigations to determine its safety and feasibility profile.
Division of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France; INSERM 1099 Research Unit, LTSI University of Rennes 1, Rennes, France.
Amedeo
A
Anselmi
Division of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France; INSERM 1099 Research Unit, LTSI University of Rennes 1, Rennes, France.
Vito Giovanni
VG
Ruggieri
Division of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France; INSERM 1099 Research Unit, LTSI University of Rennes 1, Rennes, France.
Majid
M
Harmouche
Division of Cardiac Surgery, Angers University Hospital, Angers, France.
Olivier
O
Fouquet
Division of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France; INSERM 1099 Research Unit, LTSI University of Rennes 1, Rennes, France.
Adrien
A
Kaladji
Division of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France; INSERM 1099 Research Unit, LTSI University of Rennes 1, Rennes, France.
Erwan
E
Flécher
Division of Cardiac Anesthesia, Pontchaillou University Hospital, Rennes, France.
Xavier
X
Beneux
Division of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France; INSERM 1099 Research Unit, LTSI University of Rennes 1, Rennes, France.
Antoine
A
Lucas
Division of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France; INSERM 1099 Research Unit, LTSI University of Rennes 1, Rennes, France. Electronic address: jean-philippe.verhoye@chu-rennes.fr.
Jean-Philippe
JP
Verhoye
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome