title: Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Single-center results of the first 100 patients.
abstract: OBJECTIVE
  Combined disease of the aortic arch and the proximal descending aorta remains a surgical challenge. The Thoraflex Hybrid graft (Vascutek, Inchinnan, United Kingdom) consists of a 4-branched graft with a stent graft at the distal end allowing a total aortic arch replacement, including the origins of the supra-aortic vessels combined with endoluminal treatment of the proximal descending aorta. We present the midterm results of our first 100 patients who were treated with this frozen elephant trunk prosthesis.
  
  
  METHODS
  From April 2010 to October 2014, 100 patients (65 men aged 59 ± 14 years) underwent operation (37 acute dissections, 31 chronic dissections, and 32 aneurysms). Fifty-four percent of patients received concomitant cardiac procedures, and 28% were reoperations.
  
  
  RESULTS
  The perioperative mortality was 7% (n = 7). Midterm survival after a follow-up of 3.1 ± 1.4 years was 81% (n = 81). Mean cardiopulmonary bypass time was 243 ± 61 minutes, cardiac ischemia time was 101 ± 65 minutes, and circulatory arrest time was 51 ± 20 minutes. Aortic root replacement was performed in 41 patients (n = 41; valve-sparing: 30% [n = 30]). Twenty-two percent of patients underwent secondary aortic reinterventions during follow-up (15% planned second stage operations). Sixty percent of reinterventions were performed via endovascular approach. Acute dissection patients needed significantly fewer reinterventions (n = 3; 8%).
  
  
  CONCLUSIONS
  The Thoraflex Hybrid graft adds to the frozen elephant trunk concept for treating aortic arch and descending aortic disease. Implantation of the Thoraflex Hybrid graft resulted in excellent outcomes and beneficial aortic remodeling during follow-up. This graft increases surgeons' armamentarium in the treatment of complex and diverse aortic arch pathology.
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany. Electronic address: shrestha.malakh.lal@mh-hannover.de.
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Kaufeld
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Beckmann
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Fleissner
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Umminger
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Firas
authors.initials: F
authors.lastname: Abd Alhadi
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Boethig
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Krueger
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Martens
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D000072226:Computed Tomography Angiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: FET; acute aortic dissection; aortic arch surgery; branched graft technique; frozen elephant trunk; hybrid prosthesis