Single-Center Experience With the Thoraflex™ Hybrid Prosthesis: Indications, Implantation Technique and Results

Konrad Wisniewski; Arash Motekallemi; Angelo M Dell'Aquila; Alexander Oberhuber; Johannes F Schaefers; Abdulhakim Ibrahim; Sven Martens; Andreas Rukosujew

doi:10.3389/fcvm.2022.924838

Single-Center Experience With the Thoraflex™ Hybrid Prosthesis: Indications, Implantation Technique and Results

Front Cardiovasc Med. 2022 May 30:9:924838. doi: 10.3389/fcvm.2022.924838. eCollection 2022.

Authors

Konrad Wisniewski¹, Arash Motekallemi¹, Angelo M Dell'Aquila¹, Alexander Oberhuber², Johannes F Schaefers², Abdulhakim Ibrahim², Sven Martens¹, Andreas Rukosujew¹

Affiliations

¹ Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
² Department of Vascular and Endovascular Surgery, University Hospital Muenster, Muenster, Germany.

Abstract

Objective: The aim of this study was to evaluate the early and mid-term results after the frozen elephant trunk (FET) procedure for the treatment of complex arch and proximal descending aortic disease in a single-center institution.

Methods: From April 2015 to July 2021, 72 patients (25 women, 60.4 ± 10.3 years) underwent Thoraflex™ Hybrid implantation at our institution. The indications were thoracic aortic aneurysm (TAA) (n = 16, 22.2%), post-dissection aneurysm (n = 21, 29.2%), and acute aortic dissection (AAD) (n = 35, 48.6%). Antegrade cerebral perfusion under moderate hypothermia (28°C) was employed in all cases. Eighteen patients (25%) have already been operated due to heart or aortic disease.

Results: Overall in-hospital mortality was 12.5% (9 patients). Rates of permanent neurological dysfunction and spinal cord injury were 9.7 and 5.5%, respectively. The in-hospital mortality rate among patients operated on AAD, TAA, and post-dissection aneurysm were 8.6, 6.2, and 23.8%, respectively. At a mean follow-up of 26 ± 20 months, mortality was 9.7%. Furthermore, 23 patients (31.9%) required a subsequent procedure in distal aorta: endovascular stentgraft extension in 19 patients (26.4%) and open aortic surgery in 4 patients (5.5%). The mid-term survival of patients with type A aortic dissection was 97%.

Conclusions: Our experience with the Thoraflex Hybrid prosthesis demonstrates its surgical applicability for different types of aortic pathologies with promising outcomes during early and midterm follow-up. Our technique and perioperative management lead to comparable or even superior neurological outcomes and mortality in urgent cases considering other high-volume centers.

Keywords: Thoraflex Hybrid prosthesis; acute aortic dissection (AAD); frozen elephant trunk (FET); post-dissection aneurysm; thoracic aortic aneurysm (TAA).