Aortic arch replacement with frozen elephant trunk-when not to use it

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• The frozen elephant trunk (FET) technique is integral to modern aortic arch repair for aneurysmal disease and acute aortic dissection.
• Its application varies from therapeutic exclusion of the descending thoracic aorta in aneurysms to prophylactic prevention of dilatation in acute aortic dissection type A.

Purpose of the Study:

• To review the historical evolution of the FET technique and prosthesis development.
• To explore challenges and limitations in evidence-based surgical research for aortic arch reconstruction.
• To present outcomes from recent FET applications in complex aortic arch repair.

Main Methods:

• Historical review of FET technique and prosthesis development.
• Analysis of current scientific evidence and surgical research limitations.
• Presentation of clinical data from 27 patients undergoing 4-branch FET aortic arch reconstruction.

Main Results:

• The FET technique has evolved significantly, offering improved therapeutic and prophylactic options.
• Evidence-based research in this field faces specific challenges.
• The 4-branch FET approach in 27 complex patients demonstrated 0% morbidity and mortality.

Conclusions:

• The FET technique is a cornerstone in managing aortic arch pathologies.
• Continued research and technological advancements are vital for optimizing outcomes.
• The 4-branch FET shows promising results in reducing complications for complex aortic arch reconstructions.