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Frozen Elephant Trunk Technique to Minimize Circulatory Arrest and Aortic Cross-Clamp Time
Faizus Sazzad1, Mofassel Uddin Ahmed2, Jai Ajitchandra Sule2
1Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Background:
Open repair for aortic arch aneurysms is the gold standard, but prolonged circulatory arrest time and aortic cross-clamp time heighten complication risks. Our team adopted a modified frozen elephant trunk (FET) implantation technique simplifying the complex arch procedure.
Methods:
The FET technique, like open and endovascular surgeries, is an evolving procedure in aortic arch repair and complex aortic pathologies. Our FET technique involves bilateral axillary artery cannulation for cardiopulmonary bypass, debranching of arch vessels with antegrade cerebral perfusion prior to circulatory arrest, and FET implantation. The circulatory arrest required only for distal graft to arch anastomosis in zones 0 to II. An early cross-clamp release after completion proximal graft to aorta anastomosis minimizes cross-clamp time and provides rapid myocardial perfusion. Mild hypothermia 28°C and 2-layer suture technique for aortic anastomosis facilitates bleeding control.
Results:
From end 2022 to beginning of 2024, we implanted 7 FET devices using this technique. The average cardiopulmonary bypass time was 231.6 minutes, with an aortic cross-clamp time of 84.6 minutes and a cardiopulmonary assist time of 31.1 minutes. Concomitant revascularization was performed in 28.6% of cases, with no instances of cerebrovascular accidents, reoperation for bleeding, or 30-day mortality reported.
Conclusions:
We found our modified technique to be a comprehensive and simple solution for FET procedures, enhancing surgical outcomes and reducing risks.
