Single centre Asian experience of first 100 cases of frozen elephant trunk procedures: Humble beginning, evolution and lessons learned

Paneer Selvam Krishna Moorthy ¹, Kiew Kong Pau ¹, Mohd Azhari Yakub ¹

⁰Department of Cardiothoracic & Vascular Surgery, National Heart Institute, Kuala Lumpur, Malaysia.

Asian Cardiovascular & Thoracic Annals +

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December 26, 2025

View abstract on PubMed

Summary

The frozen elephant trunk (FET) procedure for aortic arch disease shows improved outcomes over time. Early mortality decreased significantly, and surgical times shortened, indicating enhanced recovery with experience.

Area Of Science

Cardiovascular Surgery
Thoracic Surgery
Vascular Surgery

Background

The frozen elephant trunk (FET) technique addresses complex aortic arch pathologies.
Single-center experience with FET procedures over time is valuable for understanding outcomes.

Purpose Of The Study

To evaluate the evolution of early and late outcomes in 100 consecutive frozen elephant trunk (FET) procedures.
To identify learning curves and improvements in FET operations over time.

Main Methods

Retrospective review of 100 patients undergoing FET procedures between January 2016 and January 2024.
Patients divided into two groups (first 50 vs. subsequent 50 cases) for comparative analysis of outcomes.
Analysis of early mortality, morbidity (stroke, SCI, renal dialysis), operative times, and long-term survival.

Main Results

Early overall mortality decreased from 12% in the first 50 cases to 6% in the subsequent 50 (p=0.295).
No deaths occurred in isolated FET procedures.
Operative times (total, cross-clamp, circulatory arrest, cerebral perfusion) were significantly shorter in the second group (p<0.05).
Significant risk factors for mortality included CABG, prolonged clamp time, deep hypothermia, and prolonged ventilation.
1, 5, and 7-year survival rates were 93.8%, 90.7%, and 82.5%, respectively.

Conclusions

The frozen elephant trunk (FET) procedure demonstrates improved safety and efficiency with accumulating surgical experience.
Refined surgical techniques and enhanced post-operative care contribute to better patient recovery and reduced mortality.
FET operations are becoming faster with better patient outcomes, highlighting the importance of case volume and technique optimization.

Keywords:

Frozen elephant trunk aortic arch aortic dissection thoracic aortic aneurysm