Single-Stage Treatment of Extensive Aortic Pathology Using the Frozen Elephant Trunk Procedure

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Surgery
• Minimally Invasive Techniques

Background:

• Traditional treatment for extensive aortic arch and descending aorta pathology involves two open surgical procedures.
• The frozen elephant trunk (FET) procedure presents a single-stage alternative for managing complex aortic conditions.

Purpose of the Study:

• To evaluate the institutional experience and outcomes of the single-stage frozen elephant trunk procedure for extensive aortic pathology.
• To assess the safety and efficacy of FET in treating degenerative aneurysms and post-dissection aneurysms involving the aortic arch and descending aorta.

Main Methods:

• Nine patients with extensive aortic pathology underwent the frozen elephant trunk procedure between June 2018 and October 2019.
• Procedures involved selective antegrade cerebral perfusion and mild systemic hypothermia (28°C) for organ protection.
• Patient conditions included chronic aneurysms, type B aortic dissection, penetrating aortic ulcers, and reoperative cases.

Main Results:

• No early mortality was observed. One patient experienced a focal stroke, and two developed unilateral vocal cord palsy.
• Two patients required reexploration for bleeding; no spinal cord injury, prolonged ventilation, or major organ failure occurred.
• Mid-term mortality was 22% due to pneumonia, with two patients requiring thoracic endovascular aortic repair (TEVAR) extension for endoleak.

Conclusions:

• The frozen elephant trunk procedure is a viable single-stage option for extensive aortic arch and descending aorta pathology.
• This technique offers acceptable mortality and morbidity rates for patients with chronic degenerative or post-dissection aneurysms.
• FET facilitates a consolidated treatment approach for complex aortic diseases involving both the arch and descending aorta.