The Thoraflex hybrid frozen elephant trunk device: The Bologna experience

Aim: Extensive thoracic aorta lesions represent a challenging pathology in cardiac surgery. In the last years, hybrid procedures have been introduced for the treatment of these complex aortic diseases. The frozen elephant trunk (FET) procedure, combining conventional surgery with endovascular techniques, allows single-stage treatment for such pathology. Here we present our initial experience with the single-stage FET procedure using the latest commercially available hybrid prosthesis: the Thoraflex hybrid device. Methods: Between March 2013 and March 2014,11 patients underwent thoracic aorta surgery using the FET approach with the Thoraflex hybrid device. Indications for surgery were residual type A chronic dissection in 8 patients, chronic aneurysm of the distal arch in 2 patients and type B chronic aortic dissection in 1 patient Eight patients had already undergone aortic interventions through a median sternotomy. Brain protection was achieved by means of antegrade selective cerebral perfusion (ASCP) and moderate hypothermia (26 °C) in all cases. Results: Overall, in-hospital mortality was 0%. No patient presented spinal cord injury or major neurological events. Only one patient experienced transient ischemic attack. Two patients underwent reoperation for bleeding. One patient had renal failure needing temporary dyalisis. All postoperative angio CT-Scans confirmed the desired results. Conclusion: Our initial experience, although based on only eleven patients, showed excellent survival at 30 days with absence of paraplegia and major neurological events. Thoraflex hybrid prosthesis with the four-branched arch graft increases the spectrum of techniques available for the surgeon in the treatment of complex diseases of the thoracic aorta.