Skip to main content
SpringerLink
Log in

Short- and mid-term outcomes of the frozen elephant-trunk procedure for degenerative aortic arch aneurysm

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The frozen elephant-trunk (FET) procedure is used widely in total aortic arch replacement (TAR) surgery; however, its safety, effectiveness, and long-term outcomes compared with those of the conventional elephant trunk (cET) procedure for degenerative aneurysms are unclear.

Methods

Between July, 2011 and August, 2019, 126 patients underwent elective total aortic arch replacement at our institution. We compared the short- and mid-term outcomes of 60 patients who underwent the FET procedure (FET group) with those of 66 patients who underwent cET (cET group).

Results

The in-hospital mortality rate tended to be lower in the FET group than in the cET group (p = 0.12). There were two cases of paraplegia (3.3%) in the FET group and in none in the cET group. The all-cause mortality at the 3-year follow-up did not differ significantly between the groups (p = 0.31). The FET group required more unexpected interventions at the surgical site in the mid-term period.

Conclusions

FET was associated with a shorter operative time and lower surgical mortality than cET. Although the mid-term total aortic arch replacement outcomes of FET were acceptable, careful imaging observation is necessary because reinterventions were required more frequently.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Leone A, Beckmann E, Aandreas M, Di Marco L, Pantaleo A, Reggiani LB, et al. Total aortic arch replacement with frozen elephant trunk technique: results from two European institutes. J Thorac Cardiovasc Surg. 2020;159:1201–11.

    Article  Google Scholar 

  2. Leontyev S, Tsagakis K, Pacini D, Di Bartolomeo R, Mohr FW, Weiss G, et al. Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: results of a multicentre study. Eur J Cardiothorac Surg. 2016;49:660–6.

    Article  Google Scholar 

  3. Mestres CA, Tsagakis K, Pacini D, Di Bartolomeo R, Grabenwöger M, Borger M, et al. One-stage repair in complex multisegmental thoracic aneurysmal disease: results of a multicentre study. Eur J Cardiothorac Surg. 2013;44:e325–31.

    Article  Google Scholar 

  4. Uchida N, Katayama A, Higashiue S, Shiono M, Hata M, Minami K, et al. A new device as an open stent graft for extended aortic repair: a multicentre early experience in Japan. Eur J Cardiothorac Surg. 2016;49:1270–8.

    Article  Google Scholar 

  5. Dohle DS, Tsagakis K, Janosi RA, Benedik J, Kühl H, Penkova L, et al. Aortic remodelling in aortic dissection after frozen elephant trunk. Eur J Cardiothorac Surg. 2016;49:111–7.

    Article  Google Scholar 

  6. Yamane Y, Uchida N, Mochizuki S, Furukawa T, Yamada K. Early- and mid-term aortic remodelling after the frozen elephant trunk technique for retrograde type A acute aortic dissection using the new Japanese J Graft open stent graft. Interact Cardiovasc Thorac Surg. 2017;25:720–6.

    Article  Google Scholar 

  7. Koizumi S, Nagasawa A, Koyama T. Total aortic arch replacement using frozen elephant trunk technique with J Graft Open Stent Graft for distal aortic arch aneurysm. Gen Thorac Cardiovasc Surg. 2018;66:91–4.

    Article  Google Scholar 

  8. Minatoya K, Inoue Y, Sasaki H, Tanaka H, Seike Y, Oda T, et al. Total arch replacement using a 4-branched graft with antegrade cerebral perfusion. J Thorac Cardiovasc Surg. 2019;157:1370–8.

    Article  Google Scholar 

  9. Ogino H, Ando M, Sasaki H, Minatoya K. Total arch replacement using a stepwise distal anastomosis for arch aneurysms with distal extension. Eur J Cardiothorac Surg. 2006;29:255–7.

    Article  Google Scholar 

  10. Kato M, Ohnishi K, Kaneko M, Ueda T, Kishi D, Mizushima T, et al. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation. 1996;94:188–93.

    Article  Google Scholar 

  11. Di Bartolomeo R, Murana G, Di Marco L, Pantaleo A, Alfonsi J, Leone A, et al. Frozen versus conventional elephant trunk technique: application in clinical practice. Eur J Cardiothorac Surg. 2017;51:i20–8.

    Article  Google Scholar 

  12. Leontyev S, Borger MA, Etz CD, Moz M, Seeburger J, Bakhtiary F, et al. Experience with the conventional and frozen elephant trunk techniques: a single-centre study. Eur J Cardiothorac Surg. 2013;44:1076–82.

    Article  Google Scholar 

  13. Shrestha M, Beckmann E, Krueger H, Fleissner F, Kaufeld T, Koigeldiyev N, et al. The elephant trunk is freezing: the Hannover experience. J Thorac Cardiovasc Surg. 2015;149:1286–93.

    Article  Google Scholar 

  14. Tsagakis K, Dohle DS, Wendt D, Wiese W, Benedik J, Lieder H, et al. Left subclavian artery rerouting and selective perfusion management in frozen elephant trunk surgery. Minim Invasive Ther Allied Technol. 2015;24:311–6.

    PubMed  Google Scholar 

  15. Xiao Z, Meng W, Zhu D, Guo Y, Zhang E. Treatment strategies for left subclavian artery during total arch replacement combined with stented elephant trunk implantation. J Thorac Cardiovasc Surg. 2014;147:639–43.

    Article  Google Scholar 

  16. Shimamura K, Kuratani T, Matsumiya G, Kato M, Shirakawa Y, Takano H, et al. Long-term results of the open stent-grafting technique for extended aortic arch disease. J Thorac Cardiovasc Surg. 2008;135:1261–9.

    Article  Google Scholar 

  17. Preventza O, Liao JL, Olive JK, Simpson K, Critsinelis AC, Price MD, et al. Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients. J Thorac Cardiovasc Surg. 2020;160:20-33.e4.

    Article  Google Scholar 

  18. Kreibich M, Bünte D, Berger T, Vötsch A, Rylski B, Krombholz-Reindl P, et al. Distal stent graft-induced new entries after the frozen elephant trunk procedure. Ann Thorac Surg. 2020. https://doi.org/10.1016/j.athoracsur.2020.02.017.

    Article  PubMed  Google Scholar 

  19. Furutachi A, Takamatsu M, Nogami E, Hamada K, Yunoki J, Itoh M, et al. Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection. Interact Cardiovasc Thorac Surg. 2019;29:753–60.

    Article  Google Scholar 

Download references

Funding

This work was not supported by any funding.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku, Kobeshi, Hyogoken, 650-0047, Japan

    Shigeki Koizumi, Masanosuke Ishigami, Hideki Tsubota & Tadaaki Koyama

Authors
  1. Shigeki Koizumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masanosuke Ishigami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideki Tsubota
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tadaaki Koyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tadaaki Koyama.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare.

Ethical approval

This study was approved by the institutional review board of Kobe City Medical Center General Hospital (No. zn200818), and informed consent was obtained from each patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koizumi, S., Ishigami, M., Tsubota, H. et al. Short- and mid-term outcomes of the frozen elephant-trunk procedure for degenerative aortic arch aneurysm. Surg Today 52, 324–329 (2022). https://doi.org/10.1007/s00595-021-02337-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-021-02337-y

Keywords

Search

Navigation