A large vegetation on a xenopericardial roll elephant trunk graft.
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ABSTRACT:
SUBMITTER: Minegishi S
PROVIDER: S-EPMC8300915 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Treatment of aortic arch aneurysms and dissections require highly complex surgical procedures with devastating complications and mortality rates. Currently, repair of the complete arch until the proximal descending thoracic aorta consists of a two-stage procedure, called elephant trunk (ET) technique, or a single stage a single-stage technique referred to as frozen elephant trunk (FET). There is conflicting evidence about the perioperative results of ET in comparison with FET. We carried out a meta-analysis to investigate possible differences in perioperative and early (up to 30 days) outcomes of ET vs. FET, particularly for mortality, spinal cord injury (SCI), stroke, and renal failure. We also performed a meta-regression to explore the effects of age and sex as possible cofactors. Twenty-one studies containing data from interventions conducted between 1997 and 2019 and published between 2008 and 2021 with 3153 patients (68.5% male) were included. ET was applied to 1,693 patients (53.7%) and FET to 1460 (46.3%). Overall mortality after ET was 250/1693 (14.8%) and after FET 116/1460 (7.9%). Relative risk (RR) and 95% confidence interval (CI) were 1.37 [1.04 to 1.81], p = 0.027. There was no significant effect of age and sex. SCI occurrence after the second stage of ET was 45/1693 (2.7%) and after FET 70/1,460 patients (4.8%) RR 0.53 [0.35 to 0.81], p = 0.004. Age and sex were not associated with the risk of SCI. No significant differences were observed between ET and FET in the incidence of stroke and renal failure. Our results indicate that ET is associated with higher early mortality but lower incidence of SCI compared to FET. When studies published in the last 5 years were analyzed, no significant differences in mortality or SCI were found between ET and FET. This difference is attributed to a decrease in mortality after ET, as the mortality after FET did not change significantly over time.
| S-EPMC9630467 | biostudies-literature
Project description: Not available
| S-EPMC10828580 | biostudies-literature
Project description: Not available
| S-EPMC10315428 | biostudies-literature
Project description:Behavior and innervation suggest a high tactile sensitivity of elephant trunks. To clarify the tactile trunk periphery we studied whiskers with the following findings. Whisker density is high at the trunk tip and African savanna elephants have more trunk tip whiskers than Asian elephants. Adult elephants show striking lateralized whisker abrasion caused by lateralized trunk behavior. Elephant whiskers are thick and show little tapering. Whisker follicles are large, lack a ring sinus and their organization varies across the trunk. Follicles are innervated by ~90 axons from multiple nerves. Because elephants don't whisk, trunk movements determine whisker contacts. Whisker-arrays on the ventral trunk-ridge contact objects balanced on the ventral trunk. Trunk whiskers differ from the mobile, thin and tapered facial whiskers that sample peri-rostrum space symmetrically in many mammals. We suggest their distinctive features-being thick, non-tapered, lateralized and arranged in specific high-density arrays-evolved along with the manipulative capacities of the trunk.
| S-EPMC10250425 | biostudies-literature
Project description: Not available
| S-EPMC8350949 | biostudies-literature
Project description:Background and objectiveThe frozen elephant trunk (FET) allows a single-stage repair of complex arch pathologies due to its stented and non-stented hybrid prosthesis (HP) features. FET inherently has its own related complications including distal stent graft-induced new entry (dSINE), failure of aortic remodelling, endoleak, reintervention, and kinking of the stent. The aim of this narrative review is to discuss the latest evidence regarding the postoperative clinical outcomes of the FET procedure. Another aim is to provide an overview of results achieved using different FET devices on the global arch prostheses market.MethodsA comprehensive literature search was conducted using multiple electronic databases to identify and extract the relevant data and information.Key content and findingsThis review found that the literature reported a 5-12% mortality rate post-FET, with varying figures depending on the prosthesis type. Between 0-18.2% of patients developed dSINE, while 0.1-28% developed endoleak. Reintervention occurred in 0-28% of patients and the incidence of kinking has been quoted between 0-8% in the literature. Reporting aortic remodelling rates was challenging due to the lack of standardisation and various measurements reported; however, all studies included in this review reported relative increase in true lumen diameter, reduction in the false lumen diameter, and/or false lumen thrombosis.ConclusionsIn conclusion, FET can achieve a favourable postoperative profile in terms of survival, complications and aortic remodelling, and remains the gold-standard treatment for thoracic aortic pathologies implicating the arch and descending thoracic aorta.
| S-EPMC10753235 | biostudies-literature
Project description:The development of the frozen elephant trunk (FET) prosthesis has revolutionised how we treat some of the most complex aortic pathology, including in the emergency setting of acute type A aortic dissection. The design of the prosthesis is fundamental to the success of the procedure in combination with the surgeon's skill in interpreting the pre-operative scan and procedural planning to juggling the technical aspects of the deployment and reimplantation of the supra-aortic vessels. Furthermore, organ protection strategies and techniques to reduce the complications of neurological and renal impairment are paramount. This article focuses on the Thoraflex Hybrid prosthesis including the evolution of the concept, design features unique to the device and surgical technique including fundamentals of sizing and implantation steps with illustrations. The Thoraflex Hybrid prosthesis provides an ergonomic and neat delivery system with a trusted gelatin coated surgical graft material making implantation and use as straightforward as possible. These features have meant that the device is a market leader in the field of FETs with outcome data and implant figures to support its efficacy globally. The success of the device is also reflected in the literature. For example, in the UK study from Mariscalco et al., the mortality of FET implantation in acute type A dissection, of which most were using the Thoraflex device, was only 12%. This is comparable to leading centres in Europe with the inherent advantage of improving long-term outcomes in addition. Of course, this strategy is not appropriate in all cases and precise judgement of when to deploy a FET in both the emergency and elective setting is key to achieving good outcomes.
| S-EPMC10315425 | biostudies-literature
Project description:Which graft material is the optimal graft material for the treatment of aortic graft infections is still a matter of controversy. We used a branched xenopericardial roll graft to replace an infected aortic arch graft as a "rescue" operation. The patient is alive and well 37 months postoperatively without recurrence of the infection and any surgical complication. This procedure may have the possibility to serve as an option for the treatment of aortic arch graft infection.
| S-EPMC6590405 | biostudies-literature
Project description:Background. Two non-tuberculous mycobacterial strains, UM_3 and UM_11, were isolated from the trunk wash of captive elephants in Malaysia. As they appeared to be identical phenotypes, they were investigated further by conventional and whole genome sequence-based methods of strain differentiation. Methods. Multiphasic investigations on the isolates included species identification with hsp65 PCR-sequencing, conventional biochemical tests, rapid biochemical profiling using API strips and the Biolog Phenotype Microarray analysis, protein profiling with liquid chromatography-mass spectrometry, repetitive sequence-based PCR typing and whole genome sequencing followed by phylogenomic analyses. Results. The isolates were shown to be possibly novel slow-growing schotochromogens with highly similar biological and genotypic characteristics. Both strains have a genome size of 5.2 Mbp, G+C content of 68.8%, one rRNA operon and 52 tRNAs each. They qualified for classification into the same species with their average nucleotide identity of 99.98% and tetranucleotide correlation coefficient of 0.99999. At the subspecies level, both strains showed 98.8% band similarity in the Diversilab automated repetitive sequence-based PCR typing system, 96.2% similarity in protein profiles obtained by liquid chromatography mass spectrometry, and a genomic distance that is close to zero in the phylogenomic tree constructed with conserved orthologs. Detailed epidemiological tracking revealed that the elephants shared a common habitat eight years apart, thus, strengthening the possibility of a clonal relationship between the two strains.
| S-EPMC4647574 | biostudies-literature
Project description:The treatment of complex multi-segment disease concomitantly affecting the aortic arch and descending thoracic aorta is technically challenging. Until the 1990s, such extensive pathology was addressed by median sternotomy for aortic arch replacement followed by a traumatic thoraco-abdominal incision for reconstruction of the descending aorta as a single- or two-stage procedure. The advent of the conventional elephant trunk procedure by Borst in 1983 simplified the second-stage of this procedure by eliminating the need for clamping of the descending thoracic aorta. However, graft-related complications and the considerable inter-stage mortality were significant limitations associated with the conventional elephant trunk procedure. The emergence of endovascular technology and availability of dedicated arch prostheses culminated in a major paradigm change with the introduction of the frozen elephant trunk (FET) concept by Kato and colleagues in the mid-1990s. This one-stage procedure permits concurrent total aortic arch replacement with antegrade delivery of a descending aortic stent-graft which itself functions as a proximal landing zone to facilitate prospective endovascular intervention to treat residual or de novo disease in the more distal aorta. The frozen elephant technique has been applied extensively in acute aortic dissection to restore true lumen patency, occlude descending aortic intimal tears and promote false lumen thrombosis, as well as for chronic degenerative arch aneurysms. The Thoraflex Hybrid and E-vita Open are the two most common commercially available hybrid FET prostheses. This review aims to discuss the development, indications, surgical technique, currently available prostheses, clinical outcomes and future directions regarding the FET procedure.
| S-EPMC9622409 | biostudies-literature