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Commentary

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

1
Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Massarenti Street 8, 40138 Bologna, Italy
2
Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, 40138 Bologna, Italy
*
Author to whom correspondence should be addressed.
Carlo Mariani and Giacomo Murana are equally contributed as first author of the manuscript.
Medicina 2021, 57(10), 1090; https://doi.org/10.3390/medicina57101090
Submission received: 20 August 2021 / Revised: 28 September 2021 / Accepted: 9 October 2021 / Published: 12 October 2021

Abstract

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.
Keywords: frozen elephant trunk; aortic dissection; aortic aneurysm frozen elephant trunk; aortic dissection; aortic aneurysm

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MDPI and ACS Style

Mariani, C.; Murana, G.; Leone, A.; Di Marco, L.; Pacini, D. Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies. Medicina 2021, 57, 1090. https://doi.org/10.3390/medicina57101090

AMA Style

Mariani C, Murana G, Leone A, Di Marco L, Pacini D. Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies. Medicina. 2021; 57(10):1090. https://doi.org/10.3390/medicina57101090

Chicago/Turabian Style

Mariani, Carlo, Giacomo Murana, Alessandro Leone, Luca Di Marco, and Davide Pacini. 2021. "Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies" Medicina 57, no. 10: 1090. https://doi.org/10.3390/medicina57101090

APA Style

Mariani, C., Murana, G., Leone, A., Di Marco, L., & Pacini, D. (2021). Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies. Medicina, 57(10), 1090. https://doi.org/10.3390/medicina57101090

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