Frozen elephant trunk in acute type A aortic dissection: surgical techniques and the extracorporeal circuit management
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CASE REPORT
Frozen elephant trunk in acute type A aortic dissection: surgical techniques and the extracorporeal circuit management Mohammed Idhrees 1 Bashi Velayudhan 1
&
Mohammed Ibrahim 1 & Arunkumar 1 & Murali Krishnaswami 1 & Aju Jacob 1 &
Received: 7 June 2020 / Revised: 7 August 2020 / Accepted: 12 August 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Acute type A aortic dissection (ATAAD) is a challenging clinical condition with immediate and late complications. Frozen elephant trunk (FET) has been offered as a solution for it promises to address the late complications—false lumen thrombosis and aortic remodelling. Here, we describe the implantation of the FET in ATAAD with the surgical technique and extracorporeal circuit management. A 54-year-old male presented with retrograde type A aortic dissection with an entry point distal to the left subclavian artery. He underwent FET using Thoraflex™ hybrid vascular prosthesis (Vascutek, Inchinnan, Scotland). Threemonth follow-up showed a complete obliteration of the false lumen in the descending thoracic aorta. FET in ATAAD is a valid option in the hands of experienced surgeons, while patient selection still remains the key in this surgery. Keywords Acute aortic dissection . Frozen elephant trunk . Thoraflex™ . Aortic surgery . Hybrid prosthesis
Introduction Acute type A aortic dissection (ATAAD) still remains a challenge to the cardiac surgeons. Among the several controversies surrounding the management of ATAAD, the most discussed topic is the management of aortic arch. Frozen elephant trunk (FET) seems to offer a solution for the shortcomings of “limited-approach” repair in ATAAD—false lumen thrombosis and aortic remodelling. The short-term results seem promising, and the long-term results are emerging in support of FET in ATAAD. We report a case of FET in ATAAD, surgical techniques, and the extracorporeal circuit management. To our best of knowledge, this is the first report in India.
Case report A 54-year-old male presented to a peripheral hospital with lower limb and abdominal pain. Ultrasound abdomen was * Mohammed Idhrees [email protected] 1
Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Vadapalani, Chennai 600 026, India
performed which showed thrombus in the infrarenal abdominal aorta. A misdiagnosis of acute limb ischemia was made and he was planned for embolectomy. A computer tomography (CT) aortogram was performed later which revealed an ATAAD, and the patient was referred to our center. CT aortogram was reviewed. It was evident that the patient had a retrograde type A aortic dissection, with an entry point 1 cm distal to the left subclavian artery (LSA) (Fig. 1). Echocardiogram showed a dissection flap in the ascending aorta, trivial aortic regurgitation, and good left ventricular function. He was planned for emergency FET surgery. Extracorporeal circuit Cardiopulmonary bypass was set up as shown in Fig. 2, with four venous lines (dual-stage right atrial
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