During the last years, hybrid devices have been introduced for the treatment of these complex aortic pathologies. The frozen elephant trunk (FET) procedure, combining conventional surgery with endovascular techniques, allows single-stage treatment. Here we present our initial experience with the single-stage FET procedure using the new hybrid ThoraflexTM (Vascutek, Scotland) prosthesis in chronic aortic pathologies.
Eight patients underwent thoracic aorta surgery using the FET approach with the ThoraflexTM hybrid device. Indications for surgery were: chronic dissection (4 patients) and degenerative aneurysms (4 patients). Brain protection was achieved by means of antegrade selective cerebral perfusion (10 ml/kg/min) and moderate hypothermia (26 °C) associated to NIRS monitoring in all cases. In 3 cases a visceral perfusion (1,5 L/min) was performed through a 18 Fr Foley catheter placed into the stented part of the hybrid prosthesis in order to reduce circulatory arrest and related complications. The hybrid device was inserted into the descending aorta on a guide-wire in all patients.
No technical problems or device related complications were registered during the procedure in all cases. The distal anastomosis to the aortic isthmus using the collar was realized first. The CBP was restarted and the proximal anastomosis was perfomed, allowing myocardial reperfusion. The supra-aortic vessels anastomoses were performed during rewarming. The hemostasis of the graft was perfect. Postoperative course was uneventful. Mean 24 h postoperative bleeding was 670 ml. No neurological complications were registered. CT scan control showed satisfactory results.
Our initial experience showed satisfactory early results with the new ThoraflexTM hybrid prosthesis for the treatment of chronic aortic pathologies. This device allows to reduce the ischemia times (myocardial and visceral) during complex and challenging surgery. Thanks to its particular features the ThoraflexTM device can make the FET technique easier and safer.