The Frozen Elephant Trunk Technique for Aortic Arch and Proximal Descending Aorta Replacement

Objective: The frozen elephant trunk (FET) technique allows for a single-stage repair of combined aortic arch and descending aortic aneurysms. Our goal is to present our experience and summarize the technical aspects and clinical outcomes of this new technique.

Methods: This 8-patient retrospective study analyzes the different aortic pathologies (4 aortic dissections: 2 type A and 2 type B, and 4 aneurysms) of 2 female and 6 male patients who underwent FET implantation in our department. The average diameter of the aortic arch and descending aorta was 62±11mm and 59±5mm, respectively. The stented end was deployed in the descending aorta through the opened aortic arch during hypothermic circulatory arrest and selective antegrade cerebral perfusion.

Results: All patients survived the procedure. Postoperative CT scans demonstrated complete thrombosis of the descending thoracic aortic aneurysm, with the exception of one patient who required descending thoracic aorta repair with an interposition graft. One patient developed neurological deficit which was completely resolved. There were two late mortalities. One patient died a year after the procedure: a redo operation (Marfan patient s/p composite aortic valve replacement) due to aortic graft infection, and the other, 7 years postoperative, due to the same cause.

Conclusions:
Diseases related to the aortic arch and descending aorta are among the great challenges in cardiovascular surgery today. The FET procedure may facilitate successful treatment in patients with this complex aortic anatomy.

Key Words: Frozen elephant trunk, Aortic aneurysm, Descending thoracic aorta.