Evaluating the risk of spinal cord ischemia in zone 2 frozen elephant trunk replacement.

Am J Surg

Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA. Electronic address:

Published: October 2022

Background: The appropriate stent length in frozen elephant trunk replacements (FET) remains debated relative to the risk for paraplegia. However, landing the distal end of the stent beyond the curve of the arch facilitates distal reintervention, which is commonly beyond the 10 cm stent coverage when deployed proximal to the left subclavian artery. The aim of this study was to evaluate outcomes following the use of 15 cm stent grafts in zone 2 (z2, distal to the left common carotid).

Methods: Using our single institution-maintained database, 103 zone 2 FET performed from 2016 to 2020 were reviewed.

Results: Of the 103 z2, a 15 cm stent graft was used in 51 operations. The indications for FET included acute and chronic aortic dissection, arch aneurysms, and pseudoaneurysms. The incidence of SCI was 0%. Seven deaths (13.7%) occurred.

Conclusions: The data demonstrates the incidence of post-operative paraplegia to be 0% with 15 cm z2 FET. The understanding of SCI in FET should not only include the stent length but also from where it begins.

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Source
http://dx.doi.org/10.1016/j.amjsurg.2022.07.011DOI Listing

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