Annals of cardiothoracic surgery最新文献

{"title":"Total aortic arch replacement with frozen elephant trunk in patients with Marfan syndrome.","authors":"Erik Beckmann, Andreas Martens, Heike Krueger, Wilhelm Korte, Tim Kaufeld, Morsi Arar, Malakh Shrestha","doi":"10.21037/acs-2025-evet-0091","DOIUrl":"10.21037/acs-2025-evet-0091","url":null,"abstract":"<p><strong>Background: </strong>Marfan syndrome (MFS) is a connective tissue disease which can lead to aortic aneurysm and dissection. The performance outcomes of total aortic arch replacement with frozen elephant trunk (FET) are not well known in these patients. This study summarizes our experience with FET in MFS.</p><p><strong>Methods: </strong>Between August 2001 and December 2021, 435 patients underwent FET at Hannover Medical School. Of these, 34 patients had MFS. The mean age was 43.3±11.9 years and 27 (79%) were male. The indication for surgery was aortic aneurysm in 1 (3%), acute aortic dissection in 12 (35%), and chronic aortic dissection in 21 (62%) patients.</p><p><strong>Results: </strong>All patients underwent total aortic arch replacement with FET. In addition, the following procedures were performed: conventional aortic root replacement (Bentall operation, n=8), valve-sparing aortic root replacement (David procedure, n=8), coronary artery bypass grafting (n=3), mitral valve surgery (n=2), and tricuspid valve surgery (n=1). Cardiopulmonary bypass (CPB) and aortic cross clamp times were 270±87 and 139±69 minutes, respectively. Postoperatively, there were 2 (6%) disabling strokes, and 0 (0%) patients required permanent dialysis or suffered from permanent paraplegia, respectively. In-hospital mortality was 12% (n=4). The mean follow-up time was 8.4±5.9 years. The 1-, 5-, 10, and 15-year survival rates were 82%, 70%, 70% and 65, respectively. There were 18 (53%) re-interventions on the distal aorta. Mean time to re-intervention was 2.7±3.1 years. The majority of patients underwent open surgical repair (n=14, 77%), while only 4 (22%) had endovascular therapy. The freedom from distal aortic re-intervention at 1-, 5-, 10- and 15 years was 86%, 61%, 55% and 44%, respectively.</p><p><strong>Conclusions: </strong>The main indication for FET surgery in MFS is acute or chronic aortic dissection. Despite multiple concomitant procedures, early mortality was relatively low, suggesting that FET is feasible and effective to treat complex aortic pathology in MFS. However, our study showed a high incidence of distal aortic re-interventions, underscoring the progressive nature of the disease and the need for tailored long-term management strategies.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"303-308"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type B dissection with retrograde progression of intramural haematoma managed with frozen elephant trunk surgery.","authors":"Alejandro Gonzalez-Caldevilla Fernandez, Ana Lopez-Marco, Aung Oo","doi":"10.21037/acs-2025-evet-0037","DOIUrl":"10.21037/acs-2025-evet-0037","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"316-318"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are frozen elephant trunks freezing out conventional ones? A systematic review and meta-analysis.","authors":"Dominic K Ng, David Downes, Rowen Osborn, Tanaka Chauraya, Ashley R Wilson-Smith","doi":"10.21037/acs-2025-evet-0058","DOIUrl":"10.21037/acs-2025-evet-0058","url":null,"abstract":"<p><strong>Background: </strong>The frozen elephant trunk (fET) has become the preeminent choice for aortic arch repair with easier second-stage endovascular solutions compared to the conventional elephant trunk (cET). Traditionally, the major advantage of cET implantation is reduced risk of spinal cord injury (SCI). With increased rates of implantation and refinement in technique, we aim to investigate if previous adverse events of fET, such as SCI, have been reduced to a level comparable to the cET.</p><p><strong>Methods: </strong>Four databases were searched from inception to January 2025. All studies reporting 30-day mortality and SCI in conventional or fETs were identified. Papers that included emergency surgery in a mixed cohort or novel and handmade prosthesis were excluded. Relevant data was extracted, and meta-analysis was conducted using a random effects model.</p><p><strong>Results: </strong>Twenty-eight studies were included with a total of 1,504 patients (122 cET, 1,382 fET). Cohort sizes ranged from 12 to 126 patients. The aggregate mean age was 60.7 years for fET and 65.6 years for cET. The 30-day mortality was 5.4% for fET and 3.9% for cET. There was a signal towards increased SCI for fET at 4.4% compared to 1.2% in cET.</p><p><strong>Conclusions: </strong>In non-emergent total arch replacement, there were similar rates of 30-day mortality. There was a signal towards increased SCI for fETs compared to cETs. Meta-regression identified a non-significant trend towards decreasing rates of SCI in fETs over time.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"247-257"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frozen elephant trunk with T-NEXT.","authors":"Paolo Berretta, Michele Galeazzi, Pietro Giorgio Malvindi, Vincenzo Vento, Emanuele Gatta, Marco Di Eusanio","doi":"10.21037/acs-2025-evet-0017","DOIUrl":"10.21037/acs-2025-evet-0017","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"314-315"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Origin of prefabricated frozen elephant trunk.","authors":"Axel Haverich, Matthias Karck","doi":"10.21037/acs-2025-evet-16","DOIUrl":"10.21037/acs-2025-evet-16","url":null,"abstract":"<p><p>At first glance, the frozen elephant trunk (FET) appears as a disruptive innovation in aortic surgery. Like any important surgical innovations, however, be it a product or a procedure, the prefabricated, four-branched device has undergone a stepwise, iterative phase of development prior to its first clinical implantation in 2010. In parallel, the surgical procedure of aortic arch replacement itself has had to mature towards a level of quality and risk control to allow for refinement via a new device. These preparatory technical steps included mastering circulatory arrest, including brain and spinal cord protection, which required decisive innovation in extracorporeal circulation (ECC) management. In addition, patient selection with respect to age and risk factors, but also his or her underlying disease-aneurysm, dissection, atherosclerosis-has been optimized prior to the introduction of the prefabricated substitute for aortic arch replacement. Of utmost importance were those steps, taken by individual surgeons and institutions by use of self-fabricated substitutes, combining various commercially available devices. Thus, the frozen elephant technique, as applied today, did not crash into the armamentarium of unprepared aortic surgeons via device engineering and industrial product development alone. Instead, it resembles an evolutionary process, guided by a number of international institutions exploring preliminary approaches, and learning from each other via scientific exchange. This process, however, would have remained unthinkable without the tremendous advances in medical imaging via tomographic techniques, including their increasing resolution and 3D depiction. This communication will focus on the intermediary surgical steps and the technological advances between the prefabrication of the FET by the medical product industry and its first successful clinical application, as it is used today.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"258-268"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frozen elephant trunk in chronic dissection.","authors":"Alessandro Leone, Roberto Di Bartolomeo, Luca Di Marco, Davide Pacini","doi":"10.21037/acs-2025-evet-0045","DOIUrl":"10.21037/acs-2025-evet-0045","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"309-310"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total aortic arch replacement using the Thoraflex Hybrid device: evolution from investigational to federally approved use in the United States.","authors":"Vicente Orozco-Sevilla, Joseph S Coselli, Susan Y Green, Veronica A Glover, Ricardo de Jesus Avendaño Garnica, Anna H Xue, Lauren K Barron, Marc R Moon","doi":"10.21037/acs-2025-evet-0070","DOIUrl":"10.21037/acs-2025-evet-0070","url":null,"abstract":"<p><strong>Background: </strong>After the US Food and Drug Administration (FDA) approved the Thoraflex Hybrid device in April 2022, hybrid devices to facilitate total arch replacement (TAR) became commercially available in the United States. However, little is known about how the Thoraflex device has been used since then. We present our experience (2016-2025) with this device.</p><p><strong>Methods: </strong>At our practice, 62 patients [median age, 65 (54-73) years] underwent frozen elephant trunk (FET) TAR with the Thoraflex device: 14 under an investigational device exemption (IDE) (2016-2018) and 48 after FDA approval (2022-2025). Both Ante-Flo (straight) and Plexus (branched) models were used.</p><p><strong>Results: </strong>Patients with aortic dissection were common (n=38; 61%). Many patients had prior open or endovascular aortic repair (n=28; 45%). Initial cannulation was commonly done via the innominate artery (n=30; 48%) or the right axillary artery (n=22; 36%). Both branched and island strategies were used to reattach the brachiocephalic arteries. Selectively, left subclavian artery (LSCA) bypass was performed before TAR in 18 patients (29%). The distal anastomosis was performed proximal to the LSCA in 27 repairs (43%). A short (10-cm) endograft extension was used in most cases (n=49; 79%). Eight (13%) patients underwent concomitant aortic root replacement. Overall, four patients (7%) had operative deaths, and three (5%) were discharged with stroke or persistent need for renal dialysis. Two patients had spinal cord deficits that resolved before discharge. Twenty-five downstream extensions (12 open, 13 endovascular) were needed in 22 patients; two patients underwent more than one repair. After discharge, seven additional patients died within one year of surgery.</p><p><strong>Conclusions: </strong>TAR is a complex procedure. Patients requiring such repair tend to have substantial disease that often eventually necessitates subsequent downstream aortic repair, especially when dissection is present. Using the Thoraflex Hybrid device in TAR results in good early outcomes and provides a reliable base for extension.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"279-290"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frozen elephant trunk in normothermia without circulatory arrest: initial experience.","authors":"Paolo Berretta, Simone D'Alessio, Pietro G Malvindi, Alessandro D'Alfonso, Mariano Cefarelli, Michele Galeazzi, Olimpia Bifulco, Martina Giusti, Vincenzo Vento, Francesca Spagnolo, Emanuele Gatta, Marco Di Eusanio","doi":"10.21037/acs-2025-evet-0042","DOIUrl":"10.21037/acs-2025-evet-0042","url":null,"abstract":"<p><strong>Background: </strong>Aortic arch surgery has evolved significantly with novel techniques aimed at reducing morbidity and mortality. Traditional approaches rely on hypothermic circulatory arrest (HCA), which remains associated with neurological and systemic complications. This study presents our initial experience with a normothermic frozen elephant trunk (FET) technique that eliminates circulatory arrest while maintaining continuous cerebral and systemic perfusion.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on consecutive patients who underwent FET without HCA at Polytechnic University of Marche from September 2019 to January 2025. The surgical strategy included femoral and innominate artery cannulation for extracorporeal circulation, antegrade selective cerebral perfusion (ASCP), and retrograde stent graft deployment with balloon occlusion. Perioperative outcomes, complications, and mid-term follow-up data were evaluated.</p><p><strong>Results: </strong>Twenty-three patients (median age, 73 years) underwent FET without HCA. Indications included degenerative aneurysm (n=14), type I endoleak (n=4), acute aortic dissection (n=2), chronic penetrating ulcer (n=2), and Kommerell's diverticulum (n=1). Technical success was 100%. Two in-hospital deaths occurred due to septic shock and stroke. No cases of permanent spinal cord injury were reported. The median intensive care unit and hospital stays were 4 and 10 days, respectively. The median peak intraoperative lactate level was 1.8 mmol/L (range, 1-4.8 mmol/L). At a median follow-up of 27 months, three patients required distal aortic reintervention due to type Ib (n=2) and type II (n=1) endoleaks.</p><p><strong>Conclusions: </strong>Normothermic FET without circulatory arrest is a feasible and potentially advantageous alternative to traditional techniques, reducing ischemia-reperfusion injury while maintaining cerebral and systemic perfusion. Early outcomes suggest promising results in selected patients, though further studies with larger cohorts are necessary to validate long-term safety and efficacy.</p><p><strong>Keywords: </strong>Frozen elephant trunk (FET); normothermic frozen elephant trunk (normothermic FET); cardiac arrest; FET without circulatory arrest; aortic arch surgery.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"291-302"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The reverse frozen elephant trunk: the Thoracoflo^® hybrid-graft.","authors":"Sabine Helena Wipper, Julia Dumfarth, Florian Enzmann, Tilo Kölbel, Sebastian Debus","doi":"10.21037/acs-2025-evet-0029","DOIUrl":"10.21037/acs-2025-evet-0029","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"311-313"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development of the Siena graft.","authors":"Eugenio Neri","doi":"10.21037/acs-2025-evet-0039","DOIUrl":"10.21037/acs-2025-evet-0039","url":null,"abstract":"<p><p>The evolution of surgical replacement of the aortic arch has been shaped by advances in surgical techniques and ancillary technologies. From the early pioneering attempts in the 1950s by Ho Ju Lin, Cooley, and DeBakey, which preceded the advent of cardiopulmonary bypass (CPB), the development of perfusion, cerebral protection, and surgical techniques, along with the evolution of prosthetic grafts, has progressively enabled surgeons to address these challenging conditions with greater confidence. Despite these remarkable advancements, aortic arch surgery still remains one of the most technically challenging procedures in cardiac surgery. A major turning point was the introduction of the elephant trunk technique by Borst in 1983. This approach allowed for staged treatment of diffuse aneurysmal disease, including both degenerative and post-dissection cases, and reduced the overall surgical risk across multiple procedures. Initially met with skepticism, the technique has since been universally adopted by centers specializing in aortic pathology. At the same time, numerous modifications to the technique have emerged. Each modification has addressed specific technical challenges or enabled the integration of new technologies. The development of the Siena graft in the early 2000s was driven by the need to harness the growing potential of endovascular devices, which had been evolving since the 1990s, and to address critical technical issues. These included the use of multi-branched prostheses and the introduction of an anastomotic collar to facilitate secure distal anastomoses, even in less-than-ideal anatomical conditions. The design of the Siena graft, now widely adopted by most manufacturers for arch grafts, required close collaboration with industry partners to ensure a reliable product from its inception. Today, the Siena graft remains a highly relevant platform for the treatment of diffuse aneurysmal disease that requires the elephant trunk technique. This paper describes the evolution and design of the graft, the technical approach, including pitfalls and safeguards, and our clinical experience.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 4","pages":"269-278"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}