The elephant trunk is freezing: The Hannover experience

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• The elephant trunk (ET) technique is a traditional method for treating complex aortic diseases affecting the aortic arch and descending aorta.
• The frozen elephant trunk (FET) technique has emerged as an increasingly utilized alternative for these conditions.
• Ongoing debate exists within the surgical community regarding the comparative efficacy of ET versus FET techniques.

Purpose of the Study:

• To compare the outcomes of the classic ET technique with the FET technique in patients undergoing total aortic arch replacement.
• To evaluate in-hospital mortality, postoperative stroke rates, and the need for subsequent procedures.

Main Methods:

• A retrospective study of 277 patients who underwent total aortic arch replacement between August 2001 and March 2013.
• Patients were divided into two groups: Group A (97 patients) received the ET procedure, and Group B (180 patients) received the FET procedure.
• Demographic and clinical data, including age, comorbidities, and type of aortic disease (aneurysm or dissection), were collected.

Main Results:

• Group A (ET) had a higher in-hospital mortality rate (24.7%) and postoperative stroke rate (12.4%) compared to Group B (FET) (12.2% and 13.3%, respectively).
• A significant proportion of ET patients (27.8%) required a second-stage procedure, while FET patients had a similar rate of further interventions in the downstream aorta (27.7%).
• FET prostheses offer an ideal landing zone for future endovascular completion, particularly beneficial for acute aortic dissection Type A.

Conclusions:

• The FET approach facilitates single-stage therapy for selected patients with combined aortic arch and descending aortic aneurysms, whereas the classic ET approach often necessitates a second operation.
• The availability of prefabricated FET hybrid prostheses contributes to significantly better outcomes, especially in patients with acute aortic dissection Type A.
• The FET technique is increasingly replacing the classic ET procedure due to its advantages in managing complex aortic pathologies.