P358. Treatment of Complex Diseases of Aorta Experience at a Single Center in Latin America Using The Frozen Elephant Trunk Technique
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Sao Paulo
Sao Paulo, São Paulo
Brazil - Contact Me
Medicine School at University of Brasília (UnB) / Brasilia
General Surgery at University of Campinas (Unicamp) / Sao Paulo
Cardiac Surgery at Heart Institute of University of Sao Paulo (InCor-USP) / Sao Paulo
ECMO Specialist (ELSO-LATAM)
Specialist in Cardiac Surgery by Brazilian Society of Cardiovascular Surgery and Brazilian Society of Medicine (SBCCV/AMB)
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
OBJECTIVE: To evaluate the short and long-term results after treatment of aneurysm or aortic dissection using the FET technique using the E®vita-Open prosthesis.
METHODS: Medical records were analyzed and data was collected from a database of patients who underwent surgery using the Frozen Elephant Trunk (FET) technique using the E-vita Open® prosthesis (Jotec GmbH, Hechingen, Germany) between Jul/2009 and Jun/2023. The adverse effects evaluated were paraplegia, stroke and AKI. Bleeding, need for re-intervention to treat remaining segments of the aorta and mortality were also assessed. Statistical program used in this study was GraphPad Prism v.10.0.1(218). The test used to compare categorical or non-categorical variables between groups was the chi-square, with a significant "p" <0.05.
RESULTS: 158 patients who underwent FET using the E-vita Open® prosthesis were evaluated. Average age was 59.1 years, with 98 (62%) patients being male. The underlying diseases corrected surgically were Aortic Aneurysm (AA) with 26%, Acute Aortic Dissection (AAD) with 13% and Chronic Aortic Dissection (CAD) with 60.1% of cases; 40 (25%) of which were re-operations. The mean maximum aortic diameter was 65.6 (14.1; 41-130) mm; the mean Cardio Pulmonary Bypass (CPB), Anoxia and Selective Cerebral Perfusion (SCP) time being respectively: 160.6 (SD 32; 92-292); 127.5 (SD 33.7; 55-249) and 60.6 (SD 12.5; 39-111) minutes. Comparing CPB, Anoxia and SCP between the groups, there was a statistically significant difference with a "p" value of respectively: 0.003; 0.005 and 0.0001. The average follow-up was 3.1 (SD 2.6; 0.07-10.12) years. The prevalence of stroke/neurological deficit within 7 days after surgery was 8.02%, with a persistent deficit for up to a year in 3.6% of cases. Limb paresis and plegia accounted for 61% of the deficits, with the comatose state in second place at 30.76%. During the postoperative period of up to 7 days, we observed the need for dialysis renal replacement therapy in 10.6% and the occurrence of acute kidney injury/injury in 25.3% of the population. There was no statistical difference between the prevalence of re-intervention between the AA, AAD and CAD groups: p=0.24 (DF 2.84). General mortality within 30 days was 14.5%, between 30 days and one year 6.9% and between one year and 5 years 3.1%. When comparing mortality within 7 days and the occurrence of dialysis AKI, there was a statistically significant difference (p=0.01).
CONCLUSIONS: In this report we observed statistically significant differences regarding the time of CPB, Anoxia and PCS, however, without apparently contributing to an increase in short- or long-term mortality when comparing the AA, AAD and CAD groups. The prevalence of stroke, paraplegia and acute kidney injury due after FET operation remains low in this new series. In this study, mortality within 30 days was observed to be lower than that of other representative single-center series and in relation to an international multicenter registry¹ˈ²ʾ³. Retrospective nature and divergence between the size of the groups treated in this sample can also influence and limit interpretations; prospective and randomized studies are needed to test hypotheses. In this service, the treatment of complex aortic diseases using the FET technique proved to be safe, effective and with good long-term results, comparable with results from other centers of excellence.
Authors
Rômullo Santos (1), Jose Augusto Duncan Santiago (2), Vagner Madrini (3), Vinicius Correia (3), Fabio Fernandes (3), Felix Ramires (3), Fabio Jatene (2), Ricardo Dias (2)
Institutions
(1) Division of Cardiac Surgery of Heart Institute of University of Sao Paulo, Sao Paulo, SP, Brazil, São Paulo, Brazil, (2) Division of Cardiac Surgery of Heart Institute of University of Sao Paulo, Sao Paulo, SP, Brazil, Sao Paulo, Brazil, (3) Division of Cardiology of Heart Institute of University of Sao Paulo, Sao Paulo, SP, Brazil, Sao Paulo, Brazil
METHODS: Medical records were analyzed and data was collected from a database of patients who underwent surgery using the Frozen Elephant Trunk (FET) technique using the E-vita Open® prosthesis (Jotec GmbH, Hechingen, Germany) between Jul/2009 and Jun/2023. The adverse effects evaluated were paraplegia, stroke and AKI. Bleeding, need for re-intervention to treat remaining segments of the aorta and mortality were also assessed. Statistical program used in this study was GraphPad Prism v.10.0.1(218). The test used to compare categorical or non-categorical variables between groups was the chi-square, with a significant "p" <0.05.
RESULTS: 158 patients who underwent FET using the E-vita Open® prosthesis were evaluated. Average age was 59.1 years, with 98 (62%) patients being male. The underlying diseases corrected surgically were Aortic Aneurysm (AA) with 26%, Acute Aortic Dissection (AAD) with 13% and Chronic Aortic Dissection (CAD) with 60.1% of cases; 40 (25%) of which were re-operations. The mean maximum aortic diameter was 65.6 (14.1; 41-130) mm; the mean Cardio Pulmonary Bypass (CPB), Anoxia and Selective Cerebral Perfusion (SCP) time being respectively: 160.6 (SD 32; 92-292); 127.5 (SD 33.7; 55-249) and 60.6 (SD 12.5; 39-111) minutes. Comparing CPB, Anoxia and SCP between the groups, there was a statistically significant difference with a "p" value of respectively: 0.003; 0.005 and 0.0001. The average follow-up was 3.1 (SD 2.6; 0.07-10.12) years. The prevalence of stroke/neurological deficit within 7 days after surgery was 8.02%, with a persistent deficit for up to a year in 3.6% of cases. Limb paresis and plegia accounted for 61% of the deficits, with the comatose state in second place at 30.76%. During the postoperative period of up to 7 days, we observed the need for dialysis renal replacement therapy in 10.6% and the occurrence of acute kidney injury/injury in 25.3% of the population. There was no statistical difference between the prevalence of re-intervention between the AA, AAD and CAD groups: p=0.24 (DF 2.84). General mortality within 30 days was 14.5%, between 30 days and one year 6.9% and between one year and 5 years 3.1%. When comparing mortality within 7 days and the occurrence of dialysis AKI, there was a statistically significant difference (p=0.01).
CONCLUSIONS: In this report we observed statistically significant differences regarding the time of CPB, Anoxia and PCS, however, without apparently contributing to an increase in short- or long-term mortality when comparing the AA, AAD and CAD groups. The prevalence of stroke, paraplegia and acute kidney injury due after FET operation remains low in this new series. In this study, mortality within 30 days was observed to be lower than that of other representative single-center series and in relation to an international multicenter registry¹ˈ²ʾ³. Retrospective nature and divergence between the size of the groups treated in this sample can also influence and limit interpretations; prospective and randomized studies are needed to test hypotheses. In this service, the treatment of complex aortic diseases using the FET technique proved to be safe, effective and with good long-term results, comparable with results from other centers of excellence.
Authors
Rômullo Santos (1), Jose Augusto Duncan Santiago (2), Vagner Madrini (3), Vinicius Correia (3), Fabio Fernandes (3), Felix Ramires (3), Fabio Jatene (2), Ricardo Dias (2)
Institutions
(1) Division of Cardiac Surgery of Heart Institute of University of Sao Paulo, Sao Paulo, SP, Brazil, São Paulo, Brazil, (2) Division of Cardiac Surgery of Heart Institute of University of Sao Paulo, Sao Paulo, SP, Brazil, Sao Paulo, Brazil, (3) Division of Cardiology of Heart Institute of University of Sao Paulo, Sao Paulo, SP, Brazil, Sao Paulo, Brazil
Presentation Duration
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