Total Arch With Hybrid Frozen Elephant Trunk Versus Branched Stented Anastomosis Frozen Elephant Trunk Repair

This study aims to evaluate the short-term outcomes of total arch replacement using 2 techniques: the branched stented anastomosis frozen elephant trunk repair (B-SAFER) under moderate hypothermia (25-28 °C), and a simplified total arch and hybrid arch frozen elephant trunk (HA-FET) reconstruction using the Thoraflex stent graft under mild hypothermia (>32 °C).

Sixty-one patients underwent total arch replacement between June 2020 and March 2024. 25 received HA-FET, and 36 received B-SAFER. Central cannulation and cerebral debranching of the innominate and left common carotid arteries were performed before circulatory arrest in both groups. Axillary cannulation led to debranching after circulatory arrest. In the HA-FET group, snares were placed circumferentially in zone 1 and zone 2 prior to circulatory arrest and deployment of FET graft; in B-SAFER, antegrade thoracic stent graft was deployed in zone 2 with left subclavian fenestration and stenting.

Mean age 57.4 ± 13.1 years, with 74% male. Acute type A was the pathology in 60% of HA-FET and 58% of B-SAFER patients. HA-FET had significantly shorter circulatory arrest times (9 vs 40 minutes, P < .001) but similar cardiopulmonary bypass and cross-clamp times. The rate of concomitant major cardiac procedure was higher in HA-FET group (13/25, 52% vs 10/36, 27%, P = .066). Neurologic dysfunction (4% vs 5.4%, P = 1) and in-hospital mortality (4% vs 8.1%, P = .64) were similar. No paraplegia occurred, and renal failure requiring dialysis occurred in 12% of HA-FET and 8.1% of B-SAFER patients (P = .68).

Both mild hypothermic total arch with hybrid FET repair and hypothermic total arch replacement utilizing B-SAFER technique provide safe and favourable short-term outcomes. Further studies with larger cohorts and long-term follow-up are required.