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.