Initial clinical outcome of total arch replacement using novel frozen elephant trunk in the　surgical treatment of aortic arch pathology

P0172 

Abstract Submission 

Takeshi Shimamoto (1), Kenji Minatoya (2), Tatsuhiko Komiya (3), Nobuhisa Ohno (4), Nobushige Tamura (5), Naoki Kanemitsu (6), Yoshio Arai (7), Hiroshi Tsuneyoshi (8), Jiro Esaki (9)

(1) Hamamatsu Rosai Hospital, Hamamatsu, (2) Kyoto University Hospital, Kyoto, (3) Kurashiki Central Hospital, Kurashiki, (4) Kokura Memorial Hospital, Kokura, (5) Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, (6) Japan Red Cross Society Wakayama Medical Center, Wakayama, (7) Tenri Hospital, Tenri, (8) Shizuoka General Hospital, Shizuoka, (9) Kobe Central Municipal Hospital, Kobe

Takeshi Shimamoto    -  Contact Me
Hamamatsu Rosai Hospital

*Kenji Minatoya    -  Contact Me
Kyoto University Hospital

Tatsuhiko Komiya    -  Contact Me
Kurashiki Central Hospital

Nobuhisa Ohno    -  Contact Me
Kokura Memorial Hospital

Nobushige Tamura    -  Contact Me
Hyogo Prefectural Amagasaki General Medical Center

Naoki Kanemitsu    -  Contact Me
Japan Red Cross Society Wakayama Medical Center

Yoshio Arai    -  Contact Me
Tenri Hospital

Hiroshi Tsuneyoshi    -  Contact Me
Shizuoka General Hospital

Jiro Esaki    -  Contact Me
Kobe Central Municipal Hospital

Takeshi Shimamoto    -  Contact Me
N/A

Objective
Recently, a newly designed frozen elephant trunk (FET) for the surgical treatment of aortic arch lesions has been developed. This FET, named "partial FET", has a 6 cm stent portion and a 2 cm distal non-stented portion. It is designed to reduce the stent induced new entry(SINE) by reducing springback force by 43% and radial force by 29%, and to facilitate anastomosis between the unstented portion and the new graft in the second stage of surgery through a left thoracotomy. We aim to determine the perioperative and short-term clinical outcomes of total arch replacement with the partial FET.
Methods
Between August and December of 2023, a total of 16 patients with aortic arch pathology were treated with partial FET in 6 institutions enrolled in this study. The primary endpoint is the technical success of partial FET implantation. The secondary endpoint is death and aortic events including the occurrence of distal stent graft induced new entry. Numerical values were expressed mean±standard deviation.

Results
Age was 62±10 and 8 were female. The operation is indicated for acute aortic dissection in 10, chronic aortic dissection in 5 and anastomotic pseudoaneurysm in 1 patient. The re-do were 2 cases. The preoperative malprefusion existed in 2 patients( 1 coronary and 1 cerebral with symptom). The total arch replacement with the partial frozen elephant trunk was technically successfully performed in all the patients. The concomitant procedures were valve-sparing aortic root replacement in 2, Bentall operation in 1 and CABG in 1 patient. The circulatory arrest time, the aortic cross-clamp time and the cardiopulmonary bypass time were 62±17, 176±66, 271±65 min, respectively. No postoperative pressure gradient between upper and lower extremities were observed, except one case of chronic dissection whose true lumen was severely stenosed and the cause of pressure gradient was not the presence of unstented portion of partial FET. The 30-day and in-hospital mortality was 0%. The postoperative new stroke, paraplegia, paraparesis were not observed. There were no aorta-related complications such as distal stent graft-induced new entry.

Conclusions
The early outcomes of total arch replacement with the partial frozen elephant trunk procedure were acceptable. Care must be taken for the use in chronic aortic dissection because of its decent radial and spring back force.

Dissection