METHODS
This is a single center, retrospective, observational study based on prospectively collected data obtained from institutional cardiac surgery dataset at University Hospital San Giovanni di Dio and Ruggi d’Aragona in Salerno, Italy. The study was conducted in accordance with the principles of the Declaration of Helsinki. Institutional board approval was obtained for the study, and patient consent was waived.
All patients who underwent FET for acute and chronic arch and thoracic aorta pathologies between December 2017 and May 2020 were included. The dates were chosen to capture all routine use of the Thoraflex Hybrid FET device which consists of a proximal unstented tubular gelatin-coated Dacron graft and a distal stent-graft polyester made with a self-expandable nitinol skeleton, deployable antegrade during circulatory arrest over a guidewire. The unstented proximal graft diameters vary from 22—32 mm, the distal stent-graft from 24—40 mm. We use exclusively the Plexus configuration with four integrated lateral branches: three for the reconstruction of supra-aortic vessels and one for systemic perfusion. A sewing collar between the two portions facilitates the distal anastomosis and improves hemostasis. Two different distal lengths are available (100 and 150 mm). The combination of the different sizes and lengths allow to tailor the graft to each patient’s anatomy.
We size the stent-graft portion according to the aortic diameter of the distal landing zone as evaluated by preoperative CT angiogram: 0% oversizing in acute and chronic aortic dissections; 10—15% oversizing in ascending aorta and/or arch aneurysms, particularly when a second stage was anticipated. In order to minimize the risk of spinal cord ischemia, we only implant the 100 mm length.