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Journal of Cardiothoracic Surgery

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Open Access 01-12-2023 | Aneurysm | Research

Extra-anatomical left common carotid and subclavian artery bypass followed by aortic arch replacement with frozen elephant trunk

Authors: Ryo Suzuki, Masafumi Akita, Suguru Miyazaki, Ryo Shimano

Published in: Journal of Cardiothoracic Surgery | Issue 1/2023

Abstract

Background

Total arch replacement (TAR) using a frozen elephant trunk (FET) allows for simultaneous treatment of the aortic arch and descending aortic pathology via median sternotomy. In addition, an extra-anatomical bypass performed between the left common carotid artery (CCA) and subclavian artery (SCA) prior to TAR allowed further proximalisation of the FET prosthesis, facilitated distal anastomosis of the TAR and spared the demanding left subclavian artery (LSA) anastomosis in the deep thorax. We investigated the efficacy of this debranching-first technique, followed by TAR using a frozen elephant trunk, as a two-stage operation for extensive thoracic aortic aneurysms in high-risk patients.

Methods

Forty-nine consecutive patients with diffuse degenerative aneurysms from the aortic arch to the descending aorta or chronic aortic dissection who underwent left common carotid to subclavian artery bypass followed by TAR using a frozen elephant trunk and subsequent thoracic endovascular aortic repair between 2016 and 2021 were analysed. The baseline characteristics and clinical outcomes were assessed. The estimated overall survival, 5-year aortic event-free survival, and aortic reintervention rates were analysed.

Results

The average European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was 4.7 ± 2.5. The operative mortality rate was 4.1%, with no paraplegia events. The estimated 5-year overall survival, cumulative aortic-related mortality rates were 76.8% and 2%, respectively. The estimated 5-year overall cumulative aortic reintervention rate, including the intended intervention, was 31.3%. The estimated 5-year cumulative rate of non-intended reintervention was 4.5%.

Conclusions

The assessed technique enables a less technically demanding surgery with reasonable outcomes. The estimated 5-year aortic event-free survival and reintervention rates were acceptable, suggesting that multiple stages of alternative open and endovascular interventions, such as this technique, may reduce the morbidity and mortality rates of high-risk patients with diffuse thoracic aortic aneurysm.

UMIN-CTR (University hospital Medical Information Network-Clinical Trial Registry)

https://center6.umin.ac.jp/cgi-open-bin/ctr_e/index.cgi

Clinical registration number: UMIN000051531

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Title: Extra-anatomical left common carotid and subclavian artery bypass followed by aortic arch replacement with frozen elephant trunk
Authors: Ryo Suzuki
Masafumi Akita
Suguru Miyazaki
Ryo Shimano
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Aneurysm
Aneurysm
Paraplegia
Aortic Aneurysm
Aortic Aneurysm
Published in: Journal of Cardiothoracic Surgery / Issue 1/2023
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-023-02403-1

2024 ASCO Annual Meeting

Springer Medicine

Extra-anatomical left common carotid and subclavian artery bypass followed by aortic arch replacement with frozen elephant trunk

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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