Is the frozen elephant trunk procedure superior to the conventional elephant trunk procedure for completion of the second stage?
Abstract OBJECTIVES Our goal was to compare the results and outcomes of second-stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease. METHODS Between August...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2017-10, Vol.52 (4), p.725-732 |
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| container_title | European journal of cardio-thoracic surgery |
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| creator | Rustum, Saad Beckmann, Erik Wilhelmi, Mathias Krueger, Heike Kaufeld, Tim Umminger, Julia Haverich, Axel Martens, Andreas Shrestha, Malakh |
| description | Abstract
OBJECTIVES
Our goal was to compare the results and outcomes of second-stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease.
METHODS
Between August 2001 and December 2014, 53 patients [mean age 61 ± 13 years, 64% (n = 34) male] underwent a second-stage completion procedure. Of these patients, 32% (n = 17) had a previous ET procedure and 68% (n = 36) a previous FET procedure as a first-stage procedure.
RESULTS
The median times to the second-stage procedure were 7 (0–78) months in the ET group and 8 (0–66) months in the FET group. The second-stage procedure included thoracic endovascular aortic repair in 53% (n = 28) of patients and open surgical repair in 47% (n = 25). More endovascular interventions were performed in FET patients (61%, n = 22) than in the ET group (35%, n = 6, P = 0.117). The in-hospital mortality rate was significantly lower in the FET (8%, n = 3) group compared with the ET group (29%, n = 5, P = 0.045). The median follow-up time after the second-stage operation for the entire cohort was 4.6 (0.4–10.4) years. The 5-year survival rate was 76% in the ET patients versus 89% in the FET patients (log-rank: P = 0.11).
CONCLUSIONS
We observed a significantly lower in-hospital mortality rate in the FET group compared to the ET group. This result might be explained by the higher rate of endovascular completion in the FET group. We assume that the FET procedure offers the benefit of a more ideal landing zone, thus facilitating endovascular completion. |
| doi_str_mv | 10.1093/ejcts/ezx199 |
| format | Article |
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OBJECTIVES
Our goal was to compare the results and outcomes of second-stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease.
METHODS
Between August 2001 and December 2014, 53 patients [mean age 61 ± 13 years, 64% (n = 34) male] underwent a second-stage completion procedure. Of these patients, 32% (n = 17) had a previous ET procedure and 68% (n = 36) a previous FET procedure as a first-stage procedure.
RESULTS
The median times to the second-stage procedure were 7 (0–78) months in the ET group and 8 (0–66) months in the FET group. The second-stage procedure included thoracic endovascular aortic repair in 53% (n = 28) of patients and open surgical repair in 47% (n = 25). More endovascular interventions were performed in FET patients (61%, n = 22) than in the ET group (35%, n = 6, P = 0.117). The in-hospital mortality rate was significantly lower in the FET (8%, n = 3) group compared with the ET group (29%, n = 5, P = 0.045). The median follow-up time after the second-stage operation for the entire cohort was 4.6 (0.4–10.4) years. The 5-year survival rate was 76% in the ET patients versus 89% in the FET patients (log-rank: P = 0.11).
CONCLUSIONS
We observed a significantly lower in-hospital mortality rate in the FET group compared to the ET group. This result might be explained by the higher rate of endovascular completion in the FET group. We assume that the FET procedure offers the benefit of a more ideal landing zone, thus facilitating endovascular completion.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezx199</identifier><identifier>PMID: 28655150</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><subject>Adult ; Aged ; Aorta, Thoracic - surgery ; Aortic Aneurysm, Thoracic - diagnostic imaging ; Aortic Aneurysm, Thoracic - mortality ; Aortic Aneurysm, Thoracic - surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - methods ; Blood Vessel Prosthesis Implantation - mortality ; Cardiopulmonary Bypass - methods ; Cohort Studies ; Endovascular Procedures - methods ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prosthesis Design ; Retrospective Studies ; Risk Assessment ; Statistics, Nonparametric ; Survival Analysis ; Thoracotomy - methods ; Time Factors ; Treatment Outcome</subject><ispartof>European journal of cardio-thoracic surgery, 2017-10, Vol.52 (4), p.725-732</ispartof><rights>The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2017</rights><rights>The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-b4cb8da50dd213b8bba2e708a54a6965258b6efa84931d7de479cba130f379033</citedby><cites>FETCH-LOGICAL-c361t-b4cb8da50dd213b8bba2e708a54a6965258b6efa84931d7de479cba130f379033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28655150$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rustum, Saad</creatorcontrib><creatorcontrib>Beckmann, Erik</creatorcontrib><creatorcontrib>Wilhelmi, Mathias</creatorcontrib><creatorcontrib>Krueger, Heike</creatorcontrib><creatorcontrib>Kaufeld, Tim</creatorcontrib><creatorcontrib>Umminger, Julia</creatorcontrib><creatorcontrib>Haverich, Axel</creatorcontrib><creatorcontrib>Martens, Andreas</creatorcontrib><creatorcontrib>Shrestha, Malakh</creatorcontrib><title>Is the frozen elephant trunk procedure superior to the conventional elephant trunk procedure for completion of the second stage?</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>Abstract
OBJECTIVES
Our goal was to compare the results and outcomes of second-stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease.
METHODS
Between August 2001 and December 2014, 53 patients [mean age 61 ± 13 years, 64% (n = 34) male] underwent a second-stage completion procedure. Of these patients, 32% (n = 17) had a previous ET procedure and 68% (n = 36) a previous FET procedure as a first-stage procedure.
RESULTS
The median times to the second-stage procedure were 7 (0–78) months in the ET group and 8 (0–66) months in the FET group. The second-stage procedure included thoracic endovascular aortic repair in 53% (n = 28) of patients and open surgical repair in 47% (n = 25). More endovascular interventions were performed in FET patients (61%, n = 22) than in the ET group (35%, n = 6, P = 0.117). The in-hospital mortality rate was significantly lower in the FET (8%, n = 3) group compared with the ET group (29%, n = 5, P = 0.045). The median follow-up time after the second-stage operation for the entire cohort was 4.6 (0.4–10.4) years. The 5-year survival rate was 76% in the ET patients versus 89% in the FET patients (log-rank: P = 0.11).
CONCLUSIONS
We observed a significantly lower in-hospital mortality rate in the FET group compared to the ET group. This result might be explained by the higher rate of endovascular completion in the FET group. We assume that the FET procedure offers the benefit of a more ideal landing zone, thus facilitating endovascular completion.</description><subject>Adult</subject><subject>Aged</subject><subject>Aorta, Thoracic - surgery</subject><subject>Aortic Aneurysm, Thoracic - diagnostic imaging</subject><subject>Aortic Aneurysm, Thoracic - mortality</subject><subject>Aortic Aneurysm, Thoracic - surgery</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - methods</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Cardiopulmonary Bypass - methods</subject><subject>Cohort Studies</subject><subject>Endovascular Procedures - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prosthesis Design</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Statistics, Nonparametric</subject><subject>Survival Analysis</subject><subject>Thoracotomy - methods</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kDtPwzAURi0EoqWwMSNvMBBqx3nYE0IVj0pILCCxRbZzQ1OSONgOgk78dNKmsMHkO5zzyToIHVNyQYlgU1hq76aw-qBC7KAx5SkLUhY97_Y3oSRIRURG6MC5JSEkYWG6j0YhT-KYxmSMvuYO-wXgwpoVNBgqaBey8djbrnnFrTUa8s4Cdl0LtjQWe7PhtWneofGlaWT1t1X0gjZ1W8GaxKbYuA56O8fOyxe4PER7hawcHG3fCXq6uX6c3QX3D7fz2dV9oFlCfaAirXguY5LnIWWKKyVDSAmXcSQTkcRhzFUCheSRYDRPc4hSoZWkjBQsFYSxCTobdvvfvXXgfFaXTkNVyQZM5zIqaBRzKgjt0fMB1dY4Z6HIWlvW0n5mlGTr5tmmeTY07_GT7XKnash_4Z_IPXA6AKZr_5_6BuTKj4o</recordid><startdate>20171001</startdate><enddate>20171001</enddate><creator>Rustum, Saad</creator><creator>Beckmann, Erik</creator><creator>Wilhelmi, Mathias</creator><creator>Krueger, Heike</creator><creator>Kaufeld, Tim</creator><creator>Umminger, Julia</creator><creator>Haverich, Axel</creator><creator>Martens, Andreas</creator><creator>Shrestha, Malakh</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20171001</creationdate><title>Is the frozen elephant trunk procedure superior to the conventional elephant trunk procedure for completion of the second stage?</title><author>Rustum, Saad ; Beckmann, Erik ; Wilhelmi, Mathias ; Krueger, Heike ; Kaufeld, Tim ; Umminger, Julia ; Haverich, Axel ; Martens, Andreas ; Shrestha, Malakh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-b4cb8da50dd213b8bba2e708a54a6965258b6efa84931d7de479cba130f379033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortic Aneurysm, Thoracic - diagnostic imaging</topic><topic>Aortic Aneurysm, Thoracic - mortality</topic><topic>Aortic Aneurysm, Thoracic - surgery</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - methods</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Cardiopulmonary Bypass - methods</topic><topic>Cohort Studies</topic><topic>Endovascular Procedures - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prosthesis Design</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Statistics, Nonparametric</topic><topic>Survival Analysis</topic><topic>Thoracotomy - methods</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rustum, Saad</creatorcontrib><creatorcontrib>Beckmann, Erik</creatorcontrib><creatorcontrib>Wilhelmi, Mathias</creatorcontrib><creatorcontrib>Krueger, Heike</creatorcontrib><creatorcontrib>Kaufeld, Tim</creatorcontrib><creatorcontrib>Umminger, Julia</creatorcontrib><creatorcontrib>Haverich, Axel</creatorcontrib><creatorcontrib>Martens, Andreas</creatorcontrib><creatorcontrib>Shrestha, Malakh</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rustum, Saad</au><au>Beckmann, Erik</au><au>Wilhelmi, Mathias</au><au>Krueger, Heike</au><au>Kaufeld, Tim</au><au>Umminger, Julia</au><au>Haverich, Axel</au><au>Martens, Andreas</au><au>Shrestha, Malakh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is the frozen elephant trunk procedure superior to the conventional elephant trunk procedure for completion of the second stage?</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2017-10-01</date><risdate>2017</risdate><volume>52</volume><issue>4</issue><spage>725</spage><epage>732</epage><pages>725-732</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>Abstract
OBJECTIVES
Our goal was to compare the results and outcomes of second-stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease.
METHODS
Between August 2001 and December 2014, 53 patients [mean age 61 ± 13 years, 64% (n = 34) male] underwent a second-stage completion procedure. Of these patients, 32% (n = 17) had a previous ET procedure and 68% (n = 36) a previous FET procedure as a first-stage procedure.
RESULTS
The median times to the second-stage procedure were 7 (0–78) months in the ET group and 8 (0–66) months in the FET group. The second-stage procedure included thoracic endovascular aortic repair in 53% (n = 28) of patients and open surgical repair in 47% (n = 25). More endovascular interventions were performed in FET patients (61%, n = 22) than in the ET group (35%, n = 6, P = 0.117). The in-hospital mortality rate was significantly lower in the FET (8%, n = 3) group compared with the ET group (29%, n = 5, P = 0.045). The median follow-up time after the second-stage operation for the entire cohort was 4.6 (0.4–10.4) years. The 5-year survival rate was 76% in the ET patients versus 89% in the FET patients (log-rank: P = 0.11).
CONCLUSIONS
We observed a significantly lower in-hospital mortality rate in the FET group compared to the ET group. This result might be explained by the higher rate of endovascular completion in the FET group. We assume that the FET procedure offers the benefit of a more ideal landing zone, thus facilitating endovascular completion.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>28655150</pmid><doi>10.1093/ejcts/ezx199</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adult Aged Aorta, Thoracic - surgery Aortic Aneurysm, Thoracic - diagnostic imaging Aortic Aneurysm, Thoracic - mortality Aortic Aneurysm, Thoracic - surgery Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - methods Blood Vessel Prosthesis Implantation - mortality Cardiopulmonary Bypass - methods Cohort Studies Endovascular Procedures - methods Female Follow-Up Studies Hospital Mortality Humans Kaplan-Meier Estimate Male Middle Aged Prosthesis Design Retrospective Studies Risk Assessment Statistics, Nonparametric Survival Analysis Thoracotomy - methods Time Factors Treatment Outcome |
| title | Is the frozen elephant trunk procedure superior to the conventional elephant trunk procedure for completion of the second stage? |
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