[Extensive disease of the thoracic aorta: hybrid treatment with the frozen elephant trunk technique].

Abstract BACKGROUND: Aneurysms of the aortic arch extending beyond the origin of the left subclavian artery represent a challenging pathology in aortic surgery and, most commonly, are treated with different surgical, endovascular or hybrid two-staged procedures. In 2006, we initiated an intense surgical program with the frozen elephant trunk procedure that, combining together conventional surgery with endovascular techniques, allows single-stage treatment of patients with extended disease of the thoracic aorta. We here describe our surgical technique and the results with the single-stage frozen elephant trunk procedure. METHODS: Between January 2007 and August 2010, 87 patients were treated with the frozen elephant trunk procedure in our institution. The mean age was 62 \ub1 10 years. Indications for surgery included: chronic aneurysm (n=28; 32.2%), acute type A dissection (n=5; 5.7%), acute type B dissection (n=2; 2.3%), chronic type A dissection (n=41; 47.2%), chronic type B dissection (n=11; 12.6%). Forty-nine patients (56.4%) had undergone previous cardiac/aortic operations. Sixty-four associated aortic/cardiac operations were performed. RESULTS: Hospital mortality was 12.6%. Postoperatively, major neurological complications occurred in 4 patients (4.5%) and paraplegia in 6 (6.9%). Follow-up was 100% completed at a mean time of 15.0 \ub1 12.4 months. Estimated 3-year survival was 72.7 \ub1 8.3%. Endovascular extension was required in 14 patients (16.0%) with a technical/procedural success of 100%. CONCLUSIONS: Our preliminary results with the frozen elephant trunk in the above-mentioned high-risk group of patients were encouraging. The frozen elephant trunk, as a single-stage hybrid procedure, avoids peculiar drawbacks of staged procedures such as cumulative mortality of two major aortic procedures, interval mortality and failure to complete the final stage

Short- and midterm results after hybrid treatment of chronic aortic dissection with the frozen elephant trunk technique

Abstract OBJECTIVE: The purpose of this study was to examine our experience with the frozen elephant trunk in patients with chronic aortic dissection. METHODS: In our Institution, between January 2007 and August 2010, 49 patients (mean age: 59.6 ± 9.0 years) underwent total arch replacement with the frozen elephant trunk technique for chronic aortic dissection (type A, n=2; residual type A, n=37; type B, n=10). Forty patients (81.6%) patients had undergone previous cardiovascular procedures. Associated cardiac procedures were indicated in 21 (42.8%) patients. Brain protection was achieved with antegrade selective cerebral perfusion in all cases. RESULTS: Hospital mortality (n=5) was 10.2%. Postoperative serious complications included coma (n=3; 6.1%), paraplegia (n=2; 4.1%), respiratory failure (n=6; 12.2%), and definitive dialysis (n=2; 4.1%). Follow-up was 100% completed (mean period: 12.9 ± 11.7 months). The estimated 1- and 3-year survival rates were 91.2 ± 4.2% and 81.6 ± 6.5%, respectively. Endovascular extension was required in 11 (22.4%) patients, with technical success of 100%. Complete thrombosis of the peri-stent false lumen was achieved in 82.9% of cases, with significant reduction of the false lumen diameter (preoperative: 36 ± 11 mm; postoperative: 24 ± 17 mm; p=0.001) and increase of the true lumen diameter (preoperative: 15 ± 5 mm; postoperative: 26 ± 6 mm; p=0.001). CONCLUSIONS: The frozen elephant trunk technique, allowing treatment of extensive disease of the thoracic aorta, was associated with encouraging short- and midterm results. Longer-term follow-up is warranted

The Frozen Elephant Trunk for the treatment of chronic dissection of the thoracic aorta: a multicenter experience.

A-Link(opens in a new window)|Entitled full text(opens in a new window)|View at Publisher| Export | Download | Add to List | More... Annals of Thoracic Surgery Volume 92, Issue 5, November 2011, Pages 1663-1670 The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: A multicenter experience (Article) Pacini, D.a , Tsagakis, K.b, Jakob, H.b, Mestres, C.-A.c, Armaro, A.a, Weiss, G.d, Grabenwoger, M.d, Borger, M.A.e, Mohr, F.W.e, Bonser, R.S.f, Di Bartolomeo, R.a a Department of Cardiac Surgery, Sant' Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy b Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, Essen, Germany c Department of Cardiovascular Surgery, Hospital Cl\uednico, University of Barcelona, Barcelona, Spain View additional affiliations View references (24) Abstract Background: Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique. Methods: Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry. Ninety of the patients, who were the population in the present study, underwent operations for chronic dissection of the aorta (type A, 77%). The mean age of these 90 patients was 57 \ub1 12 years, and 72 (80%) of the patients were male. Sixty-two patients (69%) had undergone a previous aortic operation. All of the procedures in the study were performed with the aid of antegrade selective cerebral perfusion. Results: Total replacement of the aortic arch was done in 84 patients (93%). Cardiopulmonary bypass, myocardial ischemia, cerebral perfusion, and visceral ischemia times were 243 \ub1 65, 145 \ub1 48, 86 \ub1 24, and 75 \ub1 22 minutes, respectively. In-hospital mortality was 12% (11 patients). One patient died from a stroke and 8 patients (9%) died from ischemic spinal cord injury. The false lumen (FL) in the patients' aortae was evaluated with computed tomography after operation and during follow up. The rates of complete thrombosis of the FL around the elephant trunk were 69% and 79% at the first and last postoperative examinations, respectively. The rates of 4-year survival and freedom from aortic reoperation were 78% \ub1 5% and 96% \ub1 3%, respectively. Conclusions: The treatment of chronic aortic dissection (AD) with the FET technique is feasible, with respectable results. The rate of aortic reoperation with the use of this technique appears to be lower than that with a conventional approach to the repair of chronic AD. Ischemic spinal cord injury represents a concerning complication of the FET technique but seems to be unrelated to thrombosis of the FL

AMPK promotes survival of c-Myc-positive melanoma cells by suppressing oxidative stress.

Although c-Myc is essential for melanocyte development, its role in cutaneous melanoma, the most aggressive skin cancer, is only partly understood. Here we used the <i>Nras</i> <sup> <i>Q61K</i> </sup> <i>INK4a</i> <sup>-/-</sup> mouse melanoma model to show that c-Myc is essential for tumor initiation, maintenance, and metastasis. c-Myc-expressing melanoma cells were preferentially found at metastatic sites, correlated with increased tumor aggressiveness and high tumor initiation potential. Abrogation of c-Myc caused apoptosis in primary murine and human melanoma cells. Mechanistically, c-Myc-positive melanoma cells activated and became dependent on the metabolic energy sensor AMP-activated protein kinase (AMPK), a metabolic checkpoint kinase that plays an important role in energy and redox homeostasis under stress conditions. AMPK pathway inhibition caused apoptosis of c-Myc-expressing melanoma cells, while AMPK activation protected against cell death of c-Myc-depleted melanoma cells through suppression of oxidative stress. Furthermore, TCGA database analysis of early-stage human melanoma samples revealed an inverse correlation between C-MYC and patient survival, suggesting that C-MYC expression levels could serve as a prognostic marker for early-stage disease