The frozen elephant trunk surgery: a systematic review analysis

Marco, Luca Di; Murana, Giacomo; Fiorentino, Mariafrancesca; Amodio, Ciro; Mariani, Carlo; Leone, Alessandro; Bartolomeo, Roberto Di; Pacini, Davide

doi:10.1007/s12055-019-00815-0

Cited by 18 publications

(12 citation statements)

References 33 publications

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“…The frozen elephant trunk (FET) technique for total arch replacement (TAR) was introduced in 2003 and has been in use to treat a wide range of complex aortic pathologies ( 1 ). This marked an evolution from the two-stage elephant trunk (ET) procedure which involved replacing the ascending aorta and arch with a graft, followed by placement of an “elephant trunk” prosthetic that extended into the descending aorta.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Jubouri

Kayali

Saha

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortivascular surgery by allowing hybrid repair of complex aortic pathologies in a single step through combining an open surgical approach with an endovascular one. FET has been associated with favorable aortic remodeling, however, its is also associated with development of distal stent graft induced new entry (dSINE) tears postoperatively. The rate of aortic remodeling and the incidence of dSINE have been linked together, in addition, there seems to be a relationship between these two variables and FET insetion length as well as graft size.AimsThe scope of this review is to highlight the rate of aortic remodeling as well the incidence of dSINE associated with different FET devices available commercially. This review also aimed to investigate the relationship between aortic remodeling, dSINE, FET insertion length and FET graft size.MethodsWe conducted a comprehensive literature search using multiple electronic databases including PubMed, Ovid, Scopus and Embase in order to collate all research evidence on the above mentioned variables.ResultsThoraflex™ Hybrid Plexus seems to yield optimum aortic remodeling by promoting maximum false thrombosis as well true lumen expansion. Thoraflex Hybrid™ is also associated with the lowest incidence of dSINE post-FET relative to the other FET devices on the market. Aortic remodeling and dSINE do influence each other and are both linked with FET graft length and size.ConclusionThe FET technique for TAR shows excellent aortic remodeling but is associated with a considerable risk of dSINE development. However, Thoraflex™ Hybrid has demonstrated itself to be the superior FET device on the aortic arch prostheses market. Since aortic remodeling, dSINE, FET insertion length and stent graft size are all interconnect, the choice of FET device length and size must be made with great care for optimum results.

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Section: Introductionmentioning

confidence: 99%

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Jubouri

Kayali

Saha

et al. 2022

Front. Cardiovasc. Med.

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“…25 This decreased risk may be attributed to the shorter coverage of the DTA due to proximalization of anastomosis in Zone 2. 17,22,26 Whilst the relatively reduced complexity of the Z-2-FET certainly contributes to this significant reduction in ischaemic times, both the type of prosthesis employed, and variability in surgical technique are likely to be additional contributing factors. 17 Whilst the rates of postoperative stroke have also been suggested to be lower in patients with Z-2-FET, the selection of patients as well as the level of surgical experience have been suggested to potentially impact this, warranting further exploration of this potential relationship.…”

Section: Spinal Cord Injury (Spi)mentioning

confidence: 99%

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

Choudhury

Basharat

Zahra

et al. 2021

Vasc Endovascular Surg

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Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

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“…Perioperative cerebrospinal fluid drainage (with a target spinal pressure <12 mmHg) is recommended in elective cases where a long stent graft implantation is planned or previous vascular or endovascular surgery of the thoraco-abdominal aorta. After the implantation a mean systemic pressure > of 80 mmHg is strongly recommended [15].…”

Section: Surgical Technique-how We Do It In Bolognamentioning

confidence: 99%

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

et al. 2021

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The frozen elephant trunk technique (FET) requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft component, which is placed into the proximal descending thoracic aorta (DTA) anterogradely in the proximal descending thoracic aorta. In Europe, two hybrid prostheses are available: the E-evita Open Plus hybrid stent graft system provided by JOTEC (Hechingen, Germany) and the ThoraflexTM Hybrid (Vascutek, Inchinnan Scotland). Recommendations for use are extensive pathologies of the arch in case of acute and chronic aortic dissection, degenerative aneurysm and intramural hematoma. The FET approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally. The remarkable feature of this technique is the possibility to perform more proximally (from zone 3 to zone 0) the distal anastomosis in to the arch. This allows for an easier distal anastomosis, reduced hypothermic circulatory arrest time and decreased risk of paraplegia (<5%). Early results are promising and according to the most recent series the rate of developing post-operative renal insufficiency ranges from 3 to 10%, the risk of stroke from 3% to 8% and mortality from 8–15%. The aim of the article will be to provide some knowledge about the use and application of FET procedures in different aortic situations.

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The frozen elephant trunk surgery: a systematic review analysis

Cited by 18 publications

References 33 publications

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

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