New Frozen Elephant Trunk: Combination with Arch Replacement Using Translocation Technique and Tag Deployment via Arch Graft

Shigeru Hosaka ¹, SHUNICHIRO FUJIOKA ¹, YUSUKE IRISAWA ¹, TETSUYA HORAI ¹, KOKI TAKIZAWA ², HIROSHI OSAWA ²

¹ Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan; ² Department of Cardiovascular Surgery, Shimada General Hospital, Choshi, Japan;

Date, time and location: 2018.05.26 15:30, Exhibition area, 1st Floor. Zone – A

Abstract

Frozen elephant trunk procedure is a hybrid of open stentgrafting (OSG) and open surgery for aortic arch aneurysm. Although this procedure has widely spread especially in Japan after advent of commercialized OSG, some demerits such as increasing rate of spinal cord injury after operation, difficulties to decide the site of device deployment, and late migration of OSG were revealed.

【OBJECTIVE】 To diminish these demerits of the former procedure, we employ original new frozen elephant procedure for 7 patients.

【SURGICAL METHODS】 Under moderate hypothermic circulatory arrest and selective cerebral perfusion, aortic arch is divided at proximal site of aneurysm and total arch replacement using translocation technique with arch graft with 5cm length elephant trunk is done. Following the weaning of cardiopulmonary bypass, TAG is inserted via a branch for perfusion of the arch graft and deployed between the elephant trunk and the distal site of aneurysm.

【RESULTS】 Six patients were male and the mean age was 72 years (62 – 86 years). mean body height was 152cm, and mean body weight was 49kg. All patients were done successfully without endoleakage. In 6 patients, there were no complications and late results were good. One patient of tortuous descending aorta with severe atheromatous change was lost early postoperatively due to systemic atheroma embolization.

【CONCLUSIONS】 This new frozen elephant trunk procedure is safe and useful rather than the former procedure with OSG. We emphasize that this new procedure is simple and easily accomplished with only usual techniques of total arch replacement and TEVAR.