Preliminary results after implantation of Thoraflex™ Hybrid prosthesis for treatment of acute A-type aortic dissection: a single center experience

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Motekallemi A. , Dell' Aquila A. M., Martens S. , Rukosujew A.

Department of cardiothoracic surgery, division of cardiac surgery, University Medical Center Muenster, Germany;

Objective: Thoraflex™ Hybrid prosthesis (Vascutek, Inchinnan, United Kingdom) was initially designed for the treatment of complex aortic arch aneurysms. In our university medical center we extended the indication of this novel prosthesis for the treatment of acute A-type aortic dissection. Hereby, we report our single-center experience in 14 patients treated with Thoraflex™ Hybrid prosthesis. Methods: Between April 2015 and October 2017, 61 patients underwent aortic repair for A-type aortic dissection in our university medical center in Germany. Of this cohort 14 patients (13 male and one female patient, median age 60.1 years) underwent aortic repair using Thoraflex™ Hybrid prosthesis. Additional procedure included root replacement in 3 patients, whereas one patient received additional CABG-procedure. Results: Femoral cannulation for HLM was required in one patient, whereas the other patients were approached axillary. Mean cardiopulmonary bypass time and cardiac ischemia time were 217,7 minutes and 133,6 minutes respectively. Mean Hypothermic Circulatory Arrest (HCA) was 51,4 minutes. All surgeries were performed in mild hypothermia (mean 28°C). The 30-day mortality was 7,1% (n=1), whereas in-hospital mortality was 0%. Central neurological postoperative complications occurred in 2 patients (= 14,3%) including one patient with preoperative neurological condition (Penn class A bc). Spinal cord ischemia occurred in one patient (= 7,1%). Re-thoracotomy due to postoperative bleeding was performed in 1 patient. After a mean follow-up of 9,4 month (range: 1 – 27 month) 13 discharged patients were alive, and none of them underwent distal or proximal re-interventions. Conclusions: Thoraflex™ Hybrid prothesis graft is already being used for the management of complex arch pathologies including the proximal descending aorta. Our preliminary results with this small group of patients suggest the applicability of Thoraflex™ Hybrid prosthesisin acute A-type aortic dissections performed in mild hypothermia with relative low perioperative risk. However, further studies with larger cohorts are needed to confirm our single-center findings.

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