A Frozen Elephant Trunk Technique to reduce circulatory arrest time in hybrid aortic arch for acute aortic dissection: early and miterm outcomes in a multicentric cohort of 153 patients.

P0011 

Abstract Submission 

Guillaume Guimbretiere (1), Olivier Fouquet (2), charles-henri david (3), Stéphane Kermen (4), Yohann Foucher (5), Aurelien Vallée (6), Thibaut Schoell (7), Sébastien Gonthier (8), Julien Guihaire (9), Thierry BOURGUIGNON (10), Jean Christian Roussel (11), Eric braunberger (12), Nicolas Bonnet (13), Thomas Sénage (14)

(1) N/A, N/A, (2) Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, NA, (3) Cardio-thoracic and vascular surgery unit, CHU Nantes, nantes, NA, (4) CHU Tours, Tours, NA, (5) CIC 1402, CHU de Poitiers, Poitiers, NA, (6) Department of Cardiovascular Surgery, Marie Lannelongue Hospital, Le Plesis Robinson, NA, (7) Centre cardiologique du Nord, Saint-Denis, NA, (8) Department of Thoracic and Cardiovascular Surgery, Univsersity hospital Felix Guyon, Saint-Denis de la Réunion, France, (9) N/A, Rennes, France, (10) N/A, TOURS, France, (11) Nantes Hospital University, Nantes, France, (12) CHU Felix Guyon, Saint-Denis, NA, (13) Centre Cardiologique du Nord, Paris, France, (14) CHU Nantes, Nantes, NA

Guillaume Guimbretiere    -  Contact Me
N/A

Olivier Fouquet    -  Contact Me
Department of Thoracic and Cardiovascular Surgery, University Hospital

charles-henri david    -  Contact Me
Cardio-thoracic and vascular surgery unit, CHU Nantes

Stéphane Kermen    -  Contact Me
CHU Tours

Yohann Foucher    -  Contact Me
CIC 1402, CHU de Poitiers

Aurelien Vallée    -  Contact Me
Department of Cardiovascular Surgery, Marie Lannelongue Hospital

Thibaut Schoell    -  Contact Me
Centre cardiologique du Nord

Sébastien Gonthier    -  Contact Me
Department of Thoracic and Cardiovascular Surgery, Univsersity hospital Felix Guyon

Julien Guihaire    -  Contact Me
N/A

Thierry BOURGUIGNON    -  Contact Me
N/A

Jean Christian Roussel    -  Contact Me
Nantes Hospital University

Eric braunberger    -  Contact Me
CHU Felix Guyon

Nicolas Bonnet    -  Contact Me
Centre Cardiologique du Nord

Thomas Senage    -  Contact Me
CHU Nantes

Guillaume Guimbretiere    -  Contact Me
N/A

Objectives: A new approach for the Frozen Elephant Trunk (Simplified Delivery FET) procedure allows distal suturing on a perfused and loaded aorta in normothermia with shorter circulatory arrest time. This study compares outcomes with the conventional technique in patients treated for Acute Aortic Dissection (AAD).

Methods: A non-randomised, multicentre, retrospective study of all patients who underwent total arch replacement for AAD using either the simplified (SD-FET) or conventional FET (control) techniques. In-hospital mortality, stroke, and spinal cord injury were primary endpoints.

Results: Of the 153 patients (n=90 SD-FET; n=63 control FET), 26.8% were female and the mean age was 62±11 years. Circulatory arrest time was significantly shorter in the SD-FET group (5±3 vs 40±16 min; P <0.001). The lowest core temperature was significantly lower in the SD-FET group (34.6 ± 1 vs 25.3 ± 3 °C, P <0.001). Total operative time, CPB, and cross clamp times were significantly shorter in the SD-FET group (P <0.001), despite the significantly higher rate of concomitant procedures associated with this technique (P <0.001).
Overall, in-hospital mortality was 13.3% (n=20), 10.5% (n=9) in the SD-FET group vs 17.5% (n=11) in the control FET group (P=0.206). The rate of postoperative stroke was higher in the conventional group (12.4% vs 23.8%; P =0.065) but did not reach significance, similarly the spinal cord injury rate was lower in the SD-FET group but did not reach significance (2.2% vs 4.8%, P =0.385). SD-FET was protective for combined outcome (death and/or neurological event) with a corresponding population-average percentage of events of 17.8% (5.3–27.7) in the SD-FET group versus 30.7% (16.5–52.8) in the FET group [significant difference of -12.9% (-0.3 to -26)].
After a median follow-up of 21.4 months (range 0-81), 7 patients died during follow-up, with no difference between groups (4(4.5%) in the SD-FET group versus 3(5%) in the FET group; P=0.886). Of these deaths, 3 were due to the aorta (P =0.376). The incidence of early distal reinterventions during the first hospitalisation was not significant (7(7.8%) in the SD-FET group versus 7(11.1%) in the FET group; P=0.482), but this incidence was significantly higher in the conventional group during follow-up (3(3.3%) in the SD-FET group versus 7(14.5%) in the FET group; P =0.012).The Kaplan-Meier showed a survival rate at 12 and 24 months of 87% in the SD-FET group versus 83% in the FET group and 86% in the SD-FET group versus 80% FET (P = 0.625).

Conclusions: The SD-FET technique reduces circulatory arrest time and allows hybrid arch surgery to be performed without cooling. This approach is associated with a lower incidence of the combined criteria of death and/or neurological event.

Aortic Arch