Long-term outcomes of the frozen elephant trunk procedure: a systematic review

Abstract

Background: The frozen elephant trunk (FET) procedure remains an increasingly popular approach to address complex multi-segmental aortic pathologies, owing to their ability to promote false lumen thrombosis and reduce the need for second-stage operations. While the short-term outcomes of such procedures have been shown to be acceptable, much less is known regarding long-term outcomes. This systematic review evaluates long-term outcomes of the FET procedure.Methods: Studies with at least 12 months follow-up data on FETs were identified in four electronic databases. All studies were reviewed by two independent researchers and relevant data extracted. Long-term outcomes, including overall survival, freedom from reintervention, and freedom from aortic events, were evaluated using patient data recreated from digitized Kaplan-Meier curves.Results: Thirty-seven studies with 4,178 patients were identified. The majority of the studies focused solely on acute dissections. Average follow-up was 3.2 years. Overall survival at 1-, 3-, and 5-year was 89.6%, 85.2%, and 82.0%, respectively. Freedom from reintervention at the same timepoints were 93.9%, 89.3%, and 86.8%, respectively. Mortality, permanent neurological deficit and spinal cord injury were 10.2%, 7.7%, and 6.5%, respectively.Conclusions: Survival after the FET procedure is favorable, though ongoing close serial monitoring is essential to assess for the need for further reintervention. Larger multi-institutional registries are required to provide more robust evidence to better elucidate the patient cohort that would most benefit from the FET.

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

“…Based on a comparative meta‐analysis, 86 in comparison with the conventional procedure, the FET surgery was associated with lower rates of mortality (7.7% vs. 14.5%; OR 0.55 [95% CI 0.39–0.78; p = .0007]). Pooled estimates of mortality in other meta‐analyses were found to be around 10% among patients undergoing the FET procedure 6,86 . As the FET modality becomes more popular, the attainment of long‐term survival, finding the risk factors of adverse events, and the conduction of randomized clinical trials will provide us invaluable data to find the effectiveness of FET procedure.…”

“…The frozen elephant trunk (FET) as a novel single‐stage procedure for total arch replacement (TAR) has been widely implemented worldwide, and surgeons have an effective modality at their disposal to repair complex thoracic aortic pathologies; however, one of the main limitations of this approach comprised of the development of neurological complications, including stroke and spinal cord ischemia 3,4 . There have been several reviews to explore the impacts of the FET procedure on patients’ prognosis 5–9 . The process of aortic proximalization from Zone 3 to Zone 2 and Zone 0 using various aortic device technologies is available.…”

Tratamento cirúrgico de aneurismas e dissecções de aorta torácica por meio da técnica de frozen elephant trunk: revisão de literatura / Surgical treatment of thoracic aortic aneurysms and dissections using the frozen elephant trunk technique: a literature review

“…A maioria dos pacientes eram do sexo masculino, com variância de 70.8% a 77.2%, a hipertensão é uma comorbidade com alta prevalência entre esta população, variando de 44.9% a 76%. (Tian et al 2013;Preventza et al 2019;Tian et al 2020, Harky et al 2020.…”

“…(Tian et al 2013, Preventza et al 2019 O pior desfecho, a morte, é avaliado em todos os estudos utilizados nas comparações, com uma taxa variando de 0% a 12.8%, entretanto outros estudos, como o de Tian et al, trazem a mortalidade total de 8.3%. (Tian et al 2020).…”

“…A sobrevida desses pacientes, em 5 anos gira em torno de 63.88%. (Tian et al 2013;Preventza et al 2019;Tian et al 2020, Harky et al 2020. Neste aspecto, levando em consideração todas as informações anteriores acerca de complicações, indicações e perfil dos pacientes, percebe-se que a falta de dados e estudos a longo prazo que passem de 5 anos e ausência de dados clínicos randomizados comparativos entre a técnica FET e outras técnicas híbridas, traz uma grande limitação para o estudo da FET.…”