Evidence-based frozen elephant trunk practice: a narrative review

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• The frozen elephant trunk (FET) technique utilizes hybrid prostheses for single-stage repair of complex aortic arch pathologies.
• FET is associated with potential complications, including distal stent graft-induced new entry (dSINE), aortic remodeling failure, endoleak, reintervention, and stent kinking.

Purpose of the Study:

• To review the latest evidence on postoperative clinical outcomes following the FET procedure.
• To provide an overview of results from different FET devices used globally for aortic arch prostheses.

Main Methods:

• A comprehensive literature search was performed across multiple electronic databases.
• Relevant data and information were identified and extracted for analysis.

Main Results:

• Reported FET mortality rates range from 5-12%, varying by prosthesis type.
• Complication rates include 0-18.2% for dSINE, 0.1-28% for endoleak, 0-28% for reintervention, and 0-8% for kinking.
• Aortic remodeling showed positive trends, including increased true lumen diameter and decreased false lumen diameter/thrombosis, despite measurement standardization challenges.

Conclusions:

• The FET procedure demonstrates a favorable postoperative profile regarding survival and complication rates.
• FET is considered the gold-standard treatment for thoracic aortic pathologies involving the aortic arch and descending thoracic aorta.