Advocating the Strategies to Prevent Frozen Elephant Trunk Related Complications

Kenji Toyokawa, Hiroyuki Yamamoto, Yutaka Imoto, Kazuhisa Matsumoto, Hideaki Kanda, Tomoyuki Matsuba, Shuji Nagatomi, Yuki Ogata, Naoki Tateishi

Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

The use of commercially available Frozenix for frozen elephant trunk (FET) procedure is approved since January 2014 in Japan. Basic performance and operability has been improved than that of the homemade device. Based on the reflection of the previous home-made FET in our department, we present the current improved FET method and strategies.

In our facility, since 1990 we have used homemade FET to treat complicated thoracic aortic aneurysms in 29 cases.At that time,cerebral infarction and paraplegia occurred at high rates due to the unestablished techqinues, and satisfactory results could not be obtained. Since 2015, 35 patients with thoracic aortic aneurysm were performed aortic repair usingFrozenix. In our past experience, the incidence of cerebral infarction was high in DHCA + RCP enforcement cases, and we preferredFET with total aortic arch replacement under DHCA + SCP. Paraplegia is the grievous complication. For spinal cord protection, blood flow to the left subclavian artery (LSCA) is considered important. When SCP is performed, perfusion to the LSCA is always made. And after FET deployment, the LSCA is securely reconstructed. We always evaluate the preoperative CT at the workstation and determine the insertion length and FET diameter to succeed in deploying a FET safely and accurately.An aortic wall of the aortic arch is not necessarily normal and a varying degree of atherosclerotic changes may be encountered. Therefore, FET is inserted into the bloodless field of the aorta, and the position is decided after the FET delivery, blood flush from a femoral artery is always carried out for air and debris removal.Since the introduction of Frozenix, no operative death, no central nervous complication and paraplegiahas been encountered till date.Our cerebrospinal protection measures are generally acceptable. In FETs, it is considered important to establish a safe and universal technique for preventing complications.