Adapting the Frozen Elephant Trunk Stent-Graft Design to Patient’s Aortic Pathology Reduces Stent-Graft Mid-Term Related Complications: Concept and Outcomes of the COOK Hybrid Graft

P0029 

Abstract Submission 

Francois Dagenais (1), Rim Abdelli (2), Eric Dumont (2)

(1) Quebec Heart and Lung Insitute, Quebec, Quebec, (2) Quebec Heart and Lung Institute, Quebec, Quebec

*Francois Dagenais    -  Contact Me
Quebec Heart and Lung Insitute

Rim Abdelli    -  Contact Me
Quebec Heart and Lung Institute

Eric Dumont    -  Contact Me
Quebec Heart and Lung Institute

*Francois Dagenais    -  Contact Me
Quebec Heart and Lung Insitute

Objective: Outcomes after frozen elephant trunk (FET) stent-grafts are mainly focused on the perioperative results. Recently, concerns have been raised regarding the rates of late stent-graft induced complications such as thromboembolic events, 'septal injury new entry' tear (SINE) and type Ib endoleak.

Methods: The COOK FET graft, in addition to facilitate the FET procedure owing to its versatility in terms of arch zone anastomosis and endovascular management of the left subclavian, may also be customized by adapting the stent length, the proximal and distal diameters, the graft tapering and the distal radial stent strength to the patient's aortic diameter and pathology possibly allowing to decrease stent-graft related complications. To assess the mid-term stent-graft related complications of the COOK FET graft, results of 56 consecutive patients treated with the COOK FET were reviewed.

Results: Mean age was 64.511.2years; 35.7% (20pts) of female gender. Aortic pathology was aneurysmal disease in 15 (26.8%) pts, acute aortic dissection in 20 (35.7%) pts, chronic dissection in 11 (19.6%) pts and other aortic pathologies in 10 (17.9%) pts. Distal anastomosis was performed in zone 0 or 1 in 33 pts(59.0%), zone 2 in 21 pts(37.5%) and zone 3 in 2 pts(3.6%). Mean stent-graft length was 12055mm. Mean follow-up was 32.923.3 months; patients followed prospectively in a dedicated aortic clinic. Five-year survival was 80.2% with a 5-year freedom from aortic related death of 94.2%. Two patients presented a type Ib endoleak (93.5% 5-year freedom of type Ib); one patient with planned second stage stent-graft extension at 3 months post FET and one patient at 30 months post FET owing to progression of disease and currently treated medically. Two patients initially treated for dissection without low radial strength stents distally, presented SINE at respectively 8- and 25-months post FET; 5-year freedom from SINE of 93.6%. No patients with low-radial strength distal stents presented SINE at follow-up. Two patients required stent graft extension (one distal type Ib and one SINE case); 5-year freedom from aortic reintervention of 94.2%. No patient suffered a thrombo-embolic complication; all patients were treated long-term with 80mg of aspirin daily. No FET graft foreshortening, stent-graft collapse or fracture were observed at follow-up.

Conclusions: Late stent-graft related complications with FET stent-grafts are not uncommon and mandate long-term follow-up. The initial experience with the COOK FET demonstrates low stent-graft related complications at mid-term. Hence, the present study suggests that adapting stent-graft design to the patient's disease and anatomy may be beneficial.

Endoluminal Prostheses