Which Frozen Elephant Trunk Offers the Optimal Solution? Reflections From Essen Group

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Complex aortic arch pathologies require advanced surgical techniques.
• The Frozen Elephant Trunk (FET) procedure merges open and endovascular approaches.
• Improving safety and organ protection in FET surgery is crucial.

Purpose of the Study:

• To present refined operative techniques for Frozen Elephant Trunk (FET) surgery.
• To evaluate the safety, mortality, and morbidity of FET for complex aortic arch pathologies.
• To establish FET as a primary treatment for specific aortic conditions.

Main Methods:

• Development of advanced FET techniques at University Hospital Essen.
• Use of angioscopy for guidance and control of FET deployment.
• Implementation of selective whole body perfusion and moderate hypothermia.
• Relocation of distal anastomosis to Zone 2 for facilitated arch repair.

Main Results:

• Acceptable mortality rates in a high-risk patient cohort.
• Reduction in postoperative morbidity in recent years.
• Successful exclusion of aneurysms and false lumens in acute dissections.
• FET serves as a safe first stage for complex thoracoabdominal aortic repairs.

Conclusions:

• Frozen Elephant Trunk (FET) surgery is a safe and effective treatment for complex aortic arch and descending aorta pathologies.
• FET is the treatment of choice for distal arch aneurysms and acute aortic dissections.
• FET provides a reliable foundation for subsequent thoracoabdominal aortic repairs.