• Malakh Shrestha, Tim Kaufeld, Erik Beckmann, Felix Fleissner, Julia Umminger, Firas Abd Alhadi, Dietmar Boethig, Heike Krueger, Axel Haverich, and Andreas Martens.
• Clinic for Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany. Electronic address: shrestha.malakh.lal@mh-hannover.de.
• J. Thorac. Cardiovasc. Surg. 2016 Jul 1; 152 (1): 148-159.e1.

ObjectiveCombined disease of the aortic arch and the proximal descending aorta remains a surgical challenge. The Thoraflex Hybrid graft (Vascutek, Inchinnan, United Kingdom) consists of a 4-branched graft with a stent graft at the distal end allowing a total aortic arch replacement, including the origins of the supra-aortic vessels combined with endoluminal treatment of the proximal descending aorta. We present the midterm results of our first 100 patients who were treated with this frozen elephant trunk prosthesis.MethodsFrom April 2010 to October 2014, 100 patients (65 men aged 59 ± 14 years) underwent operation (37 acute dissections, 31 chronic dissections, and 32 aneurysms). Fifty-four percent of patients received concomitant cardiac procedures, and 28% were reoperations.ResultsThe perioperative mortality was 7% (n = 7). Midterm survival after a follow-up of 3.1 ± 1.4 years was 81% (n = 81). Mean cardiopulmonary bypass time was 243 ± 61 minutes, cardiac ischemia time was 101 ± 65 minutes, and circulatory arrest time was 51 ± 20 minutes. Aortic root replacement was performed in 41 patients (n = 41; valve-sparing: 30% [n = 30]). Twenty-two percent of patients underwent secondary aortic reinterventions during follow-up (15% planned second stage operations). Sixty percent of reinterventions were performed via endovascular approach. Acute dissection patients needed significantly fewer reinterventions (n = 3; 8%).ConclusionsThe Thoraflex Hybrid graft adds to the frozen elephant trunk concept for treating aortic arch and descending aortic disease. Implantation of the Thoraflex Hybrid graft resulted in excellent outcomes and beneficial aortic remodeling during follow-up. This graft increases surgeons' armamentarium in the treatment of complex and diverse aortic arch pathology.Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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