Advertisement

E-Vita OPEN NEO Hybrid Stent Graft: A New Frontier for Total Arch Replacement

Published:March 02, 2022DOI:https://doi.org/10.1016/j.avsg.2022.01.034

      Background

      The ever-changing landscape of aortic arch surgery necessitates a constant update on the available devices and technologies for the contemporary management of complex aortic diseases. The E-Vita OPEN NEO hybrid stent graft system offers a unique approach for aortic arch replacement with the frozen elephant trunk technique. In contrast to its predecessors and other commercially available devices, it fits to each individual patient's needs by allowing for more proximal graft anastomosis. We sought to present our initial experience with the novel E-Vita OPEN NEO hybrid stent graft system focusing on its description, optimal graft selection, operative technique, and results in a clinical setting.

      Methods

      We prospectively collected data on all patients in whom the E-Vita OPEN NEO device was used between October 2020 and May 2021. The primary outcome was perioperative or with 30-day mortality. Secondary outcomes were the incidence of neurologic complications (stroke and spinal cord ischemia) and endoleak on a postoperative computed tomography angiography.

      Results

      During the study period, six patients received the novel hybrid stent device. The mean patient age was 59.3 ± 13.3 years and 83% were male. Two patients were operated on an emergent setting due to acute Stanford type A aortic dissection and there were two reoperations in patients with a history of previous repaired type A dissection. There was no perioperative or 30-day mortality and none of the patients exhibited adverse neurologic events. Two patients required completion thoracic endovascular repair due to type Ib endoleak. One patient died after a prolonged stay in the intensive care unit due to pneumonia and multiorgan failure.

      Conclusions

      This novel device adapts to each patient's characteristics and offers a curative option for acute and chronic aortic arch and descending aortic conditions such as aneurysmal disease and aortic dissection. In addition, it offers an excellent landing station for potential endovascular therapies and allows for complete aortic remodeling.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Czerny M.
        • Pacini D.
        • Aboyans V.
        • et al.
        Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the european society for cardiology (esc) working group of cardiovascular surgery, the esc working group on aorta and peripheral vascular diseases, the european association of percutaneous cardiovascular interventions (EAPCI) of the esc and the european association for cardio-thoracic surgery (EACTS).
        Eur J Cardiothorac Surg. 2021; 59: 65-73
        • Czerny M.
        • Schmidli J.
        • Adler S.
        • et al.
        Editor's choice - current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the european association for cardio-thoracic surgery (EACTS) & the european society for vascular surgery (ESVS).
        Eur J Vasc Endovasc Surg. 2019; 57: 165-198
        • Leone A.
        • Di Marco L.
        • Coppola G.
        • et al.
        Open distal anastomosis in the frozen elephant trunk technique: initial experiences and preliminary results of arch zone 2 versus arch zone 3dagger.
        Eur J Cardiothorac Surg. 2019; 56: 564-571
        • Preventza O.
        • Liao J.L.
        • Olive J.K.
        • et al.
        Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients.
        J Thorac Cardiovasc Surg. 2020; 160: 20-33.e24
        • Tsagakis K.
        • Osswald A.
        • Weymann A.
        • et al.
        The frozen elephant trunk technique: Impact of proximalization and the four-sites perfusion technique.
        Eur J Cardio Thoracic Surg. 2021; 61: 195-203
        • Ho J.Y.K.
        • Bashir M.
        • Teh G.
        • et al.
        Launching the e-vita open neo amid covid-challenges and strategies.
        J Card Surg. 2021; 36: 793-795
        • Holubec T.
        • Van Linden A.
        • Bodelle B.
        • et al.
        Frozen elephant trunk: Minimally invasive implantation of a new trifurcated hybrid aortic prosthesis.
        Ann Thorac Surg. 2021;
        • Jakob H.
        • Idhrees M.
        • Bashir M.
        From e-vita open plus to e-vita neo and e-novia.
        J Card Surg. 2021; 36: 1814-1817
        • Tan S.
        • Bashir M.
        Prevention versus cure: is bioglue priming the optimal strategy against e-vita neo graft oozing?.
        J Card Surg. 2022; 37: 555-560
        • Kokotsakis J.
        • Anagnostakou V.
        • Kratimenos T.
        • et al.
        Frozen elephant trunk: a technique which can be offered in complex pathology to fix the whole aorta in one setting.
        J Cardiothorac Surg. 2011; 6: 66