The Fate of Conventional Elephant Trunk in the Frozen Elephant Trunk Era

Aorta, 2023 · DOI: https://doi.org/10.1055/s-0044-1786352 · Published: May 16, 2024

Simple Explanation

Conventional elephant trunk (cET) and frozen elephant trunk (FET) are surgical methods for treating thoracic aortic aneurysms and dissections. FET is becoming more popular because it can be done in one operation and has better aortic remodeling results. However, FET has a higher risk of spinal cord ischemia, and its use in patients with connective tissue disorder remains controversial.

Study Duration

Not specified

Participants

Review of multiple studies

Evidence Level

Review

Key Findings

1
FET is advantageous when pathology is confined to the proximal descending aorta, showing similar operative outcomes to cET but without needing a second-stage procedure and better false lumen remodeling.
2
FET is limited by spinal cord ischemia, though some groups are starting to circumvent this.
3
Even when second-stage intervention is needed, in-hospital mortality is lower with FET than cET, possibly because FET creates ideal landing zones for endovascular completion.

Research Summary

Conventional elephant trunk (cET) and frozen elephant trunk (FET) are two distinct approaches to the surgical treatment of thoracic aortic aneurysms and dissections. FET remains limited by spinal cord injury and applicability in patients with connective tissue disorder, although some groups have started to circumvent associated complications, likely due to growing surgical expertise. FET is trending toward becoming the universal treatment modality for extending repair to the descending aorta

Practical Implications

Surgical Planning

Surgeons should carefully consider the choice between cET and FET based on patient-specific factors, including the extent of aortic pathology, risk of spinal cord ischemia, and presence of connective tissue disorders.

Device Selection

Technical specificities of contemporary FET devices are important to consider.

Technique Refinement

Further research and refinement of surgical techniques are needed to mitigate the risk of spinal cord ischemia associated with FET and to optimize outcomes in patients with connective tissue disorders.

Study Limitations

1
Lack of direct comparison in a single-center setting
2
Meta-analyses are inherently limited in the reporting of surgical data.
3
Case series are not entirely comparable due to variable population characteristics and operative indications.

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