Frozen elephant trunk in normothermia without circulatory arrest: initial experience

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Traditional aortic arch surgery often uses hypothermic circulatory arrest (HCA), linked to neurological and systemic complications.
• Novel techniques aim to reduce morbidity and mortality in aortic arch surgery.
• This study explores a normothermic frozen elephant trunk (FET) technique without circulatory arrest.

Purpose of the Study:

• To evaluate the initial experience and outcomes of a normothermic FET technique without circulatory arrest.
• To assess the feasibility and safety of continuous cerebral and systemic perfusion during aortic arch repair.
• To compare this novel approach with traditional HCA methods.

Main Methods:

• Retrospective analysis of patients undergoing FET without HCA (September 2019 - January 2025).
• Surgical strategy included femoral/innominate artery cannulation, antegrade selective cerebral perfusion (ASCP), and retrograde stent graft deployment.
• Perioperative outcomes, complications, and mid-term follow-up data were analyzed.

Main Results:

• 100% technical success in 23 patients (median age 73).
• Two in-hospital deaths (septic shock, stroke); no permanent spinal cord injury.
• Median ICU and hospital stays were 4 and 10 days; 3 patients required reintervention at 27-month follow-up.

Conclusions:

• Normothermic FET without circulatory arrest is a viable alternative to HCA.
• This technique potentially reduces ischemia-reperfusion injury by maintaining perfusion.
• Further research with larger cohorts is needed to confirm long-term efficacy and safety.