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Early Clinical Outcomes of Hybrid Arch Frozen Elephant Trunk Repair with the Thoraflex Hybrid Graft

Chu MWA, Losenno KL, Dubois LA, Jones PM, Ouzounian M, Whitlock R, Dagenais F, Boodhwani M, Bhatnagar G, Poostizadeh A, Pozeg Z, Moon M, Kiaii B, Peterson MD; Canadian Thoracic Aortic Collaborative (CTAC) Investigators. Ann Thorac Surg. 2018 Oct 3. pii: S0003-4975(18)31347-X. doi: 10.1016/j.athoracsur.2018.07.091.

Abstract

BACKGROUND: Hybrid aortic arch surgery has evolved to include several technical variations, with most including an off-label use of a conventional thoracic endograft. We describe the early clinical outcomes of the Thoraflex Hybrid graft specifically designed for the treatment of complex arch and proximal descending aortic disease.

METHODS: Between January 2014 and April 2017, 40 consecutive patients (66±14 years, 45% female) underwent hybrid aortic arch and frozen elephant trunk (FET) repair with the multibranched Thoraflex Hybrid graft at 9 Canadian centers. Surgical indications included transverse arch/proximal descending aortic aneurysm in 100%, acute dissection in 10%, chronic dissection in 43% and acute aortic rupture in one patient. Antegrade cerebral perfusion and moderate hypothermia (24.3±1.8°C) were employed in all cases.

RESULTS: All 40 device implants were successful. The 30-day/in-hospital mortality was 5%. Stroke and transient neurological deficits occurred in 5% and 3% of patients, respectively. Two patients (5%) experienced transient spinal cord ischemia - there were no instances of permanent paraplegia. Mean follow-up was 550±328 days and late complications included type A aortic dissection in 1 patient, type B dissection in 2 patients and further distal endografting in 2 patients. Survival at 30-days, 1-year and 2-years was 95%, 95% and 90%, respectively.

CONCLUSIONS: Hybrid aortic arch and FET repair with the Thoraflex hybrid graft appears to be associated with good clinical outcomes, despite being early in the learning curve with this graft. Further investigation with this device is warranted to establish its role within the variations of hybrid arch repair.

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