matching analysis between classic and arch first technique ...€¦ · matching analysis between...

San Raffaele Scientific Institute - Vascular Surgery - “Vita-Salute” UniversitySan Raffaele Scientific Institute - Vascular Surgery - “Vita-Salute” University

Matching analysis between classic and arch first technique

in Frozen Elephant Trunk for aortic arch repair

Bertoglio L, Grandi A, Fittipaldi A, Giambuzzi I, Redaelli A, Verzini A, Cambiaghi T, Bargagna M, Alfieri O, Chiesa R, Castiglioni A

Vascular and Cardiac Surgery, “Vita-Salute” - San Raffaele University

Scientific Institute Ospedale San Raffaele, Milan – Italy

Chief: Prof. R. Chiesa – Prof. A. Castiglioni

San Raffaele Scientific Institute - Vascular Surgery - “Vita-Salute” University

Disclosure

Speaker name:

.................................................................................

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

X I do not have any potential conflict of interest


Elephant Trunk

Standard ET Borst 1983 Frozen ET Suto & Kato 1996


Frozen Elephant Trunk

E-vita Plus (Jotec) Thoraflex (Terumo-Vascutek)


FET at S. Raffaele Hospital 2009-2016

• Selective SAT cannulation for antegrade

cerebral perfusion

• Island Technique for SAT reimplantation

• E-vita Plus (Jotec) device


FET at S. Raffaele Hospital from 2017

0

1• LSA revascularization before FET

• Bilateral axillary cannulation for

bi-hemisferic cerebral perfusion

• Zone 0-1 FET anastomosis


• Novel custom-made device

• SAT debranching

• Distal aortic reperfusion


Archbranches

Limb reperfusion

Custom-Made E-Vita Graft for Frozen Elephant Trunk With Arch-First Technique.Bertoglio L, Grandi A et Al. Ann Thorac Surg. 2017 Dec;104(6):e467-e469.



• Novel custom-made device

• SAT debranching

• Distal aortic reperfusion


FET Organ Perfusion Technique study

• Ambispective study

• 20 retrospective standard FET

• 34 prospective arch-first FET (Jan 2019)

• Endpoints

Procedural data

Clinical outcomes


Matching analysis

• 10 patients per group (1:1)

• Matching criteria:

No collagenopathy

Residual dissection after Type A repair

No further cardiac procedure needed


Results – Procedural data

Standard FET Arch-first FET

Median (min)IQR

% of CPB time

Median (min)IQR

% of CPB time

p

CPB time 222,5(201,5 – 238,25)

148,5(130,75– 183,75)

0.0004

Distal aortic ischemictime

55(39 – 71.25)

24,7% 37,5(31 – 41.25)

25% 0.03

Myocardial ischemic time 148(130.75 – 183.75)

66,5% 68(61– 77.75)

45,7% 0.0001

Antegrade cerebral perfusion

85,5(77,5 – 100)

38,4% 100,5(95,5 – 116,5)

67,7% 0.069

Arch-first FET debranching time (median) 19 min (18 – 29,5)


Results – Clinical outcomesStandard FET Arch-first FET

30-days Mortality 1 (10%) 0

StrokeMajor (mRS > 3)Minor (mRS ≤ 3)

2 (20%)0

01 (10%)

Permanent SCI 0 0

Renal failureAKIN 1AKIN 2-3Temporary dialysisPermanent dialysis

1 (10%)4 (40%)1 (10%)

0

3 (30%)0

1 (10%)0

Respiratory failure 48h ET intubation Tracheostomy

5 (50%)0

1 (10%)1 (10%)

Re-intervention for bleeding 3 (30%) 0


Conclusions

• Theoretical advantages:

• Continuous antegrade cerebral flow & no direct SAT cannulation possible stroke rate reduction

• Reperfusion branch and Zone 0-1 distal anastomosis reduced distal aortic ischemia and paraplegia prevention

• Arch-branch first FET reduced cardiac ischemic times

• Initial experience safe and feasible

• Need further evaluation

San Raffaele Scientific Institute - Vascular Surgery - “Vita-Salute” UniversitySan Raffaele Scientific Institute - Vascular Surgery - “Vita-Salute” University

Matching analysis between classic and arch first technique

in Frozen Elephant Trunk for aortic arch repair

Bertoglio L, Grandi A, Fittipaldi A, Giambuzzi I, Redaelli A, Verzini A, Cambiaghi T, Bargagna M, Alfieri O, Chiesa R, Castiglioni A

Vascular and Cardiac Surgery, “Vita-Salute” - San Raffaele University

Scientific Institute Ospedale San Raffaele, Milan – Italy

Chief: Prof. R. Chiesa – Prof. A. Castiglioni

matching analysis between classic and arch first technique ...€¦ · matching analysis between...

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