European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025
Unintentional False Lumen Placement of Frozen Elephant Trunk in Aortic Dissections: Root Cause Analysis of Morphological Risk Factors.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Körfer Daniel, Wong Brian, Fujii Masahiko, Hori Daijiro, Takagi Daichi, Wortmann Markus, Geisbüsch Philipp, Manesh Michelle, Magee Gregory A, Karck Matthias, Meisenbacher Katrin, Böckler Dittmar, Peters Andreas S
Аннотация
OBJECTIVES: To analyse morphological features associated with unintentional frozen elephant trunk (FET) placement in the false lumen (FL) during aortic dissection (AD) repair.
METHODS: This multicentre retrospective study enrolled patients with acute/chronic AD with unintentional FET placement in the FL. To identify morphological features, pre-/postoperative CT, clinical and procedural data were assessed. Imaging analysis focused on size and position of the relevant (re-)entry (rE) in the distal aortic arch and postoperative FET-position.
RESULTS: Thirteen male patients (54 years, interquartile range [IQR]: 18 years) from 6 international centres were included between 2017 and 2023. Aortic pathologies comprised 5 acute Type-A-AD (38.5%), 4 acute Type-B-AD (30.8%), 1 chronic Type-B-AD (7.7%), and 3 chronic expanding residual Type-A-AD (23.1%). The rE (first [re-]entry distal to left subclavian artery [LSA] origin) had a median diameter of 15.5 mm (IQR: 9.4 mm) and was mostly located in zone 3 (61.5%), the outer curvature (61.5%), and 21.1 mm (IQR: 26.4 mm) distal to the LSA. The stented portion of the FET (FETSP) lengths measured 60-190 mm. FETSP proximal end was mostly located in zone 1 (38.5%) and at median distance of 28.2 mm (IQR: 26.5 mm) from the native LSA. FETSP distal end was mostly located in zone 5 (61.5%). Median calculated distance from rE to FETSP proximal end was 38.9 mm (IQR: 39.0 mm). Three patients (23.1%) died perioperatively; the others remained asymptomatic (follow-up: 13 mo [IQR: 15 mo]).
CONCLUSIONS: Large (re-)entries in the outer curvature of the distal aortic arch are common in patients with FET placement in the FL. Interdisciplinary collaboration with controlled, wire-guided FET placement and usage of advanced intraoperative imaging (cone-beam-CT, transesophageal echocardiography, intravascular ultrasound, angioscopy) may help minimize risk of FL deployment.
METHODS: This multicentre retrospective study enrolled patients with acute/chronic AD with unintentional FET placement in the FL. To identify morphological features, pre-/postoperative CT, clinical and procedural data were assessed. Imaging analysis focused on size and position of the relevant (re-)entry (rE) in the distal aortic arch and postoperative FET-position.
RESULTS: Thirteen male patients (54 years, interquartile range [IQR]: 18 years) from 6 international centres were included between 2017 and 2023. Aortic pathologies comprised 5 acute Type-A-AD (38.5%), 4 acute Type-B-AD (30.8%), 1 chronic Type-B-AD (7.7%), and 3 chronic expanding residual Type-A-AD (23.1%). The rE (first [re-]entry distal to left subclavian artery [LSA] origin) had a median diameter of 15.5 mm (IQR: 9.4 mm) and was mostly located in zone 3 (61.5%), the outer curvature (61.5%), and 21.1 mm (IQR: 26.4 mm) distal to the LSA. The stented portion of the FET (FETSP) lengths measured 60-190 mm. FETSP proximal end was mostly located in zone 1 (38.5%) and at median distance of 28.2 mm (IQR: 26.5 mm) from the native LSA. FETSP distal end was mostly located in zone 5 (61.5%). Median calculated distance from rE to FETSP proximal end was 38.9 mm (IQR: 39.0 mm). Three patients (23.1%) died perioperatively; the others remained asymptomatic (follow-up: 13 mo [IQR: 15 mo]).
CONCLUSIONS: Large (re-)entries in the outer curvature of the distal aortic arch are common in patients with FET placement in the FL. Interdisciplinary collaboration with controlled, wire-guided FET placement and usage of advanced intraoperative imaging (cone-beam-CT, transesophageal echocardiography, intravascular ultrasound, angioscopy) may help minimize risk of FL deployment.