Abstract
The frozen elephant trunk might be considered one of the most appreciated innovations during the last decades to treat complex thoracic aortic lesions. Many useful tips have been progressively introduced to standardize the procedures and, nowadays, the improved post-operative outcomes contributed to spread the procedure. The following article will provide a comprehensive review analysis of the Frozen Elephant Trunk (FET) technique, throughout the current available devices, possible surgical indications and primary post-operative complications.
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Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using “elephant trunk” prosthesis. Thorac Cardiovasc Surg. 1983;31:37–40.
Shrestha M, Beckmann E, Krueger H, et al. The elephant trunk is freezing: The Hannover experience. J Thorac Cardiovasc Surg. 2015;149:1286–93.
Castrovinci S, Murana G, de Maat GE, et al. The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: long-term results. J Thorac Cardiovasc Surg. 2015;149:416–22.
Suto Y, Yasuda K, Shiiya N, et al. Stented elephant trunk procedure for an extensive aneurysm involving distal aortic arch and descending aorta. J Thorac Cardiovasc Surg. 1996;112:1389–90.
Kato M, Ohnishi K, Kaneko M, et al. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation. 1996;94:II188–93.
Karck M, Chavan A, Hagl C, Friedrich H, Galanski M, Haverich A. The frozen elephant trunk technique:a new treatment for thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 2003;125:1550–3.
Sun L, Qi R, Zhu J, Liu Y, Zheng J. Total arch replacement combined with stented elephant trunk implantation: a new “standard” therapy for type a dissection involving repair of the aortic arch? Circulation. 2011;123:971–8.
Hata M, Akiyama K, Orime Y, Wakui S, Nakamura T, Shiono M. Less invasive quick open stenting using a J graft open stent for distal arch aneurysms. Thorac Cardiovasc Surg. 2016;64:330–2.
Desai ND, Pochettino A. Distal aortic remodeling using endovascular repair in acute DeBakey I aortic dissection. Semin Thorac Cardiovasc Surg. 2009 Winter;21:387–92.
Roselli EE, Rafael A, Soltesz EG, Canale L, Lytle BW. Simplified frozen elephant trunk repair for acute DeBakey type I dissection. J Thorac Cardiovasc Surg. 2013;145:S197–201.
Pacini D, Murana G, Di Marco L. Frozen elephant trunk technique: Ready to get back to the future? J Thorac Cardiovasc Surg. 2018;156:e79–80.
Pochettino A, Brinkman WT, Moeller P, et al. Antegrade thoracic stent grafting during repair of acute DeBakey I dissection prevents development of thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2009;88:482–9.
Chen X, Huang F, Xu M, et al. The stented elephant trunk procedure combined total arch replacement for DeBakey I aortic dissection: operative result and follow-up. Interact Cardiovasc Thorac Surg. 2010;11:594–8.
Uchida N, Katayama A, Tamura K, Sutoh M, Kuraoka M, Ishihara H. Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection. Eur J Cardiothorac Surg. 2011;40:1066–71.
Shen K, Tang H, Jing R, Liu F, Zhou X. Application of triple-branched stent graft for Stanford type A aortic dissection: potential risks. Eur J Cardiothorac Surg. 2012;41:e12–7.
Hoffman A, Damberg AL, Schälte G, et al. Thoracic stent graft sizing for frozen elephant trunk repair in acute type A dissection. J Thorac Cardiovasc Surg. 2013;145:964–9.
Dohle DS, Tsagakis K, Janosi RA, et al. Aortic remodelling in aortic dissection after frozen elephant trunk. Eur J Cardiothorac Surg. 2016;49:111–7.
Uchida N, Katayama A, Higashiue S, 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.
Shrestha M, Kaufeld T, Beckmann E, et al. Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Single-center results of the first 100 patients. J Thorac Cardiovasc Surg. 2016;152:148–59.
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.
Shrestha M, Martens A, Kaufeld T, et al. Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years. Eur J Cardiothorac Surg. 2017;52:858–66.
Roselli EE, Idrees JJ, Bakaeen FG, et al. Evolution of Simplified Frozen Elephant Trunk Repair for Acute DeBakey Type I Dissection: Midterm Outcomes. Ann Thorac Surg. 2018;105:749–55.
Iafrancesco M, Goebel N, Mascaro J, et al. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: results from an international multicentre registry. Eur J Cardiothorac Surg. 2017;52:310–8.
Chu MWA, Losenno KL, Dubois LA, et al. Early Clinical Outcomes of Hybrid Arch Frozen Elephant Trunk Repair With the Thoraflex Hybrid Graft. Ann Thorac Surg. 2019;107:47–53.
Qi R, Zhu JM, Liu YM, et al. Frozen Elephant Trunk for Acute Type B Dissection Involving the Distal Arch in the Hybrid Repair Era. Ann Thorac Surg. 2018;106:1182–8.
Goebel N, Nagib R, Salehi-Gilani S, et al. One-stage hybrid aortic repair using the frozen elephant trunk in acute DeBakey type I aortic dissection. J Thorac Dis. 2018;10:4195–203.
Kreibich M, Berger T, Morlock J, et al. The frozen elephant trunk technique for the treatment of acute complicated Type B aortic dissection. Eur J Cardiothorac Surg. 2018;53:525–30.
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.
Berger T, Kreibich M, Morlock J, et al. True-lumen and false-lumen diameter changes in the downstream aorta after frozen elephant trunk implantation. Eur J Cardiothorac Surg. 2018;54:375–81.
Di Bartolomeo R, Murana M, Di Marco L, et al. Is the frozen elephant trunk frozen? Gen Thorac Cardiovasc Surg. 2019;67:111–7.
Ma WG, Zheng J, Sun LZ, Elefteriades JA. Open stented grafts for frozen elephant trunk technique: technical aspects and current outcomes. Aorta. 2015;3:122–35.
Shrestha M, Bachet J, Bavaria J, et al. Current status and recommendations for use of the frozen elephant trunk technique. A position paper by the vascular domain of EACTS. Eur J Cardiothorac Surg. 2015;47:759–69.
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Di Marco, L., Murana, G., Fiorentino, M. et al. The frozen elephant trunk surgery: a systematic review analysis. Indian J Thorac Cardiovasc Surg 35 (Suppl 2), 118–126 (2019). https://doi.org/10.1007/s12055-019-00815-0
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DOI: https://doi.org/10.1007/s12055-019-00815-0