Frozen elephant trunk in acute aortic dissection: a literature review

Indian Journal of Thoracic and Cardiovascular Surgery, 2023 · DOI: https://doi.org/10.1007/s12055-023-01624-2 · Published: November 13, 2023

Cardiovascular Science Surgery

Simple Explanation

Acute aortic dissection is a life-threatening condition requiring urgent surgical treatment. The frozen elephant trunk (FET) technique has become an effective strategy for treating complex aortic pathologies. The FET technique is a valuable addition to total arch replacement procedures in patients who have distal aortic malperfusion with compression of the true lumen, complex primary and reentry tears involving the distal arch or proximal descending thoracic aorta, distal arch or descending thoracic aorta rupture, an aneurysmal arch and proximal descending thoracic aorta, or severely damaged aortic arch that makes safe distal aortic arch anastomosis challenging. The surgical management of acute aortic dissection remains challenging, but FET has shown promising results. Experienced teams have achieved acceptable in-hospital mortality and stroke rates, along with a lower risk of spinal cord injury compared to conventional repair.

Study Duration

6 to 108 months follow-up

Participants

Over 4056 FET procedures

Evidence Level

Review Article

Key Findings

1
FET is a commonly used treatment approach for acute type A aortic dissection.
2
Analysis of 12 studies, comprising over 4056 FET procedures, revealed varying rates of early mortality (up to 21.1%), perioperative stroke (ranging from 2.7 to 18.0%), and spinal cord ischemia (ranging from 0 to 8.2%).
3
During the follow-up period, which ranged from 6 to 108 months, the mortality rate was reported to be as high as 38%.

Research Summary

Acute aortic dissection is a complex and life-threatening cardiovascular disorder, requiring urgent surgical treatment. The frozen elephant trunk (FET) technique has emerged as a valuable strategy for managing these complex aortic pathologies. This review of 12 studies, encompassing over 4056 FET procedures, revealed that while the FET technique is associated with varying rates of early mortality (up to 21.1%), perioperative stroke (2.7 to 18.0%), and spinal cord ischemia (0 to 8.2%), experienced teams have achieved acceptable outcomes. The FET technique has demonstrated positive alterations in the structure of the distal aorta, potentially improving long-term survival and reducing the necessity for future procedures.

Practical Implications

Improved Surgical Outcomes

Experienced surgical teams can achieve acceptable in-hospital mortality and stroke rates using the FET technique compared to conventional repair methods.

Reduced Risk of Spinal Cord Injury

The FET technique is associated with a lower risk of spinal cord injury compared to conventional repair.

Long-Term Aortic Remodeling

The FET technique promotes positive changes in the structure of the distal aorta, potentially improving long-term survival and reducing the need for future interventions.

Study Limitations

1
The surgical treatment of acute aortic dissection continues to pose significant difficulties, even for skilled surgeons.
2
There is ongoing debate regarding its technical complexity and the longer time needed for cerebral perfusion and hypothermic circulatory arrest. These factors may increase the risks of mortality and neurological complications.
3
Due to the lack of data across the studies examined, it was impossible to retrieve specific information relative to reoperation during the follow-up period.

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