Commercial hybrid graft versus traditional arch replacement with frozen elephant trunk: A multi-institutional comparison

JTCVS open Pub Date : 2025-02-01 DOI:10.1016/j.xjon.2024.10.027

Markian M. Bojko MD, MPH , William Oslund MD , Michael J. Kirsch MD , Adam M. Carroll MD , Emma Longo BS , Jessica S. Clothier MD , Kamso Okonkwo BA , Nithya Rajeev BS , Arjune Dhanekula MD , Fenton McCarthy MD , Anthony Cafarelli MD , Jason Glotzbach MD , Christopher R. Burke MD , T. Brett Reece MD, MBA , Serge Kobsa MD, PhD , Fernando Fleischman MD

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引用次数: 0

Abstract

Objective

Traditional total arch replacement with frozen elephant trunk requires 2 separate grafts in the descending thoracic aorta and arch, and frequently requires a graft-to-graft anastomosis, which is prone to bleeding. The Thoraflex (Terumo Aortic) device treats the arch and descending thoracic aorta in a single device but has not been compared directly to traditional total arch replacement with frozen elephant trunk and has not been studied in a real-world context in the United States.

Methods

A consecutive sample of total arch replacement with frozen elephant trunk patients across 5 different institutions between January 2018 and January 2024, identified 438 patients of which 83 out of 438 (18.9%) had a Thoraflex device. Propensity score matching in a 1:2 ratio identified 166 well-matched controls. Groups were compared across perioperative outcomes.

Results

One hundred forty out of 438 (32%) patients presented with acute type A dissection, 112 out of 438 (26%) had an aneurysm, and 87 out of 438 (20%) had chronic dissection with a previous proximal repair. One hundred thirty-two out of 438 (30%) underwent surgery on an emergency or emergency/salvage basis. Median (interquartile range [IQR]) crossclamp times in the Thoraflex and traditional matched groups were 71 (IQR, 48-105) and 82 (IQR, 62-123), respectively, (P = .012). Total circulatory arrest times were 19 minutes (IQR, 13-32 minutes) and 23 minutes (IQR, 17-37 minutes), respectively (P = .009). Total procedure times were 6.1 hours (IQR, 5.2-7.3 hours) and 6.8 hours (IQR, 5.7-8.2 hours), respectively (P = .012). The operative mortality, stroke, and paralysis rates were 11 out of 83 (13%), 16 out of 83 (19%), and 4 out of 83 (5%), respectively, in the Thoraflex group and were not significantly different than matched controls.

Conclusions

The Thoraflex hybrid device facilitates shorter crossclamp and circulatory arrest times for arch replacement, with similar observed mortality and stroke rates compared with matched controls.

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商业杂交移植与传统冷冻象鼻弓置换：多机构比较

目的传统冷冻象鼻全弓置换术需要在胸降主动脉和弓处分别进行2次移植物移植，且经常需要移植物间吻合，容易出血。Thoraflex （Terumo Aortic）装置在一个装置中治疗弓和降主动脉，但没有直接与传统的冷冻象鼻全弓置换术进行比较，也没有在美国的现实环境中进行研究。方法2018年1月至2024年1月，对5家不同机构的冷冻象鼻全弓置换术患者进行连续取样，确定438例患者，其中83例（18.9%）使用Thoraflex装置。倾向得分匹配1:2的比例确定了166个匹配良好的对照。各组围手术期预后比较。结果438例患者中140例（32%）为急性A型夹层，112例（26%）为动脉瘤，87例（20%）为慢性夹层，近端修复过。438人中有132人（30%）在紧急或紧急/抢救基础上接受了手术。Thoraflex组与传统配对组的中位数（四分位间距[IQR]）分别为71次（IQR， 48 ~ 105次）和82次（IQR， 62 ~ 123次），差异有统计学意义（P = 0.012）。总循环停搏时间分别为19 min （IQR, 13 ~ 32 min）和23 min (IQR, 17 ~ 37 min) （P = 0.009）。总手术时间分别为6.1小时（IQR, 5.2 ~ 7.3小时）和6.8小时（IQR, 5.7 ~ 8.2小时）（P = 0.012）。在Thoraflex组中，手术死亡率、中风和瘫痪率分别为11 / 83（13%）、16 / 83（19%）和4 / 83(5%)，与匹配对照组相比无显著差异。结论：Thoraflex混合装置可缩短弓置换术的交叉夹持和循环停止时间，与匹配对照组相比，观察到的死亡率和卒中发生率相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JTCVS open

CiteScore

1.70

自引率

0.00%

发文量