Frozen Elephant Trunk Research Articles

Multicentre frozen elephant trunk technique experience as redo surgery to treat residual type A aortic dissections following ascending aortic replacement.

To assess the efficacy of reoperative frozen elephant trunk (FET) surgery for treating residual type A aortic dissections. Between 04/2015 and 10/2023, 237 patients underwent elective redo surgical aortic arch replacement via the FET technique to treat residual type A aortic dissection in eleven European aortic centres. Data were pooled and analysed retrospectively. The time between an acute type A dissection repair to FET implantation was 5 [1, 9] years. More than half of all patients (54%) presented with an entry within the aortic arch, and 174 patients (73%) presented residual dissections of supra-aortic vessels During FET repair, the axillary artery was cannulated in 181 patients (76%), while 83 patients (35%) underwent additional cardiac procedures including 39 root replacements (16%) and 15 coronary bypass procedures (6%). Zone 2 was the most common arch anastomosis site (n = 163, 69%) and bilateral antegrade cerebral perfusion was most frequent (n = 159, 67%). Fifteen patients (6%) suffered in-hospital mortality. Age in years (p < 0.001, OR: 1.069) proved to be predictive for overall mortality in our COX regression model. Elective redo surgical aortic arch replacement using the FET technique for treating residual type A aortic dissection following ascending aortic replacement revealed a favourable outcome. The decision to undertake stage-two therapy of a residually dissected aortic arch should be made by an aortic team on a patient-by-patient basis.

Contemporary Single-Center Experience of Complete Aortic Arch Replacement Employing the Frozen Elephant Trunk Technique in Patients with Extensive Aortic Disease

Objective: This study aimed to examine contemporary results of the frozen elephant trunk (FET) procedure in an all-comers patient cohort. Methods: Between January 2017 and May 2024, a total of 132 consecutive patients with either aortic aneurysm (n = 32), acute aortic dissection (n = 32), or chronic aortic dissection (n = 68) underwent total aortic arch replacement employing the FET technique. In-hospital data were collected prospectively and included preoperative characteristics, intraoperative data, and follow-up results. Results: The median cardiopulmonary bypass time, cardiac ischemia time, and selective antegrade cerebral perfusion time were 180 (161–205), 89 (70–113), and 45 (38–54) min, respectively. Total 30-day mortality rate was 7.6% (n = 10). The rate of major postoperative neurological complications was 6.8% (n = 9) for perioperative stroke and 2.3% (n = 3) for permanent spinal cord injury. Five patients (3.8%) required hemofiltration at the time of discharge due to postoperative kidney injury. Rates of subsequent endovascular and open aortic repair following primary FET were 40.9% (n = 54) and 3.8% (n = 5), respectively. The median time to reintervention was 86 (30–439) days. The median follow-up time was 25 (8–52) months, and overall survival rates at 1, 2, and 3 years were 89%, 89%, and 87%, respectively. Conclusions: Our data are consistent with current reports, indicating that the FET technique is a valuable adjunct in treating extensive aortic arch pathologies. The procedure provides an increasingly safe and effective option for complete aortic arch replacement, even in patients requiring a redo procedure.

Commercial Hybrid Graft versus Traditional Arch Replacement with Frozen Elephant Trunk: A Multi-Institutional Comparison

Commercial Hybrid Graft versus Traditional Arch Replacement with Frozen Elephant Trunk: A Multi-Institutional Comparison

The Frozen Elephant Trunk Procedure-8 Years of Experience from Poland.

Background: The frozen elephant trunk method combines the implantation of a Dacron prosthesis with a self-expanding stent graft, which allows for complex repairs of the aortic arch and thoracic aorta in one procedure. Despite the advantages of hybrid treatment for aortic arch aneurysms, in Poland, only a few such surgeries are performed annually compared to in Western countries. The aim of this study was to demonstrate the 8-year outcomes of treatment at the center where the Aortic Team operates, which is one of the centers in Poland with the most extensive experience in hybrid FET treatment. Methods: Patients who underwent frozen elephant trunk surgery for chronic and acute pathologies of the aortic arch and thoracic aorta between March 2016 and March 2024 were comprehensively analyzed retrospectively. Frozen elephant trunk procedures were performed under three consecutive clinical conditions: acute aortic dissection, chronic aortic dissection and redo surgery. Results: A total of 40 patients (median age: 60 years (53-66), 67.5% male) were admitted to our hospital and underwent an FET procedure. The median Euroscore II was 25.9% and the 30-day mortality was 7.5%. The 1-year and 5-year mortalities were the same, equal to 15%, with mortality cases observed only in the first and second groups of consecutive patients during the first two months of follow-up. Spinal cord injury was observed in 2.5% of patients. Conclusions: The FET technique can be successfully used to treat aortic aneurysms with optimal results and low complication rates. The surgery length, including the cardiopulmonary bypass and aortic cross-clamp times, decreased significantly with increasing experience.

Finite element analysis and computational fluid dynamics to elucidate the mechanism of distal stent graft-induced new entry after frozen elephant trunk technique.

Distal stent graft-induced new entry (dSINE), a new intimal tear at the distal edge of the frozen elephant trunk (FET), is a complication of FET. Preventive measures for dSINE have not yet been established. This study aimed to clarify the mechanisms underlying the development of dSINE by simulating the mechanical environment at the distal edge of the FET. The stress field in the aortic wall after FET deployment was calculated using finite element analysis. Blood flow in the intraluminal space of the aorta and FET models was simulated using computational fluid dynamics. The simulations were conducted with various oversizing rates of FET ranging from 0 to 30% under the condition of FET with elastic recoil. The elastic recoil of the FET, which caused its distal edge to push against the greater curvature of the aorta, induced a concentration of circumferential stress and increased wall shear stress (WSS) at the aorta. Elastic recoil also created a discontinuous notch on the lesser curvature of the aorta, causing flow stagnation. An increase in the oversizing rate of the FET widened the large circumferential stress area on the greater curvature and increases the maximum stress. Conversely, a decrease in the oversizing rate of the FET increased the WSS and widened the area with high WSS. Circumferential stress concentration due to an oversized FET and high WSS due to an undersized FET can cause a dSINE. The selection of smaller-sized FET alone might not prevent dSINE.

Luminal shape and aortic remodelling after total arch replacement for type A aortic dissection: conventional and frozen elephant trunks.

This study was performed to assess postoperative aortic remodelling (AR) after total arch replacement (TAR) for acute type A aortic dissection (AAD) with a frozen elephant trunk (FET) or conventional elephant trunk (cET). Furthermore, the shape of the residual true lumen (TL) was analyzed based on elliptical Fourier analysis (EFA) and evaluated as a predictor of AR. This study involved patients who underwent TAR with a cET or FET for AAD from December 2006 to January 2023 at five institutions. AR was assessed at the levels of the 4th thoracic vertebra (Th4), Th7, Th10, and above the coeliac trunk. The shape of the residual TL at all four levels was analyzed based on EFA to calculate shape patterns as principal component (PC) values. Inverse probability of treatment weighting (IPTW) was performed for adjustment between the groups. In total, 180 patients (88 with cET and 92 with FET) were enrolled. The complete AR rate, defined as false lumen remodelling throughout the entire descending thoracic aorta, was significantly higher in the FET than cET group (63.4% vs 32.0%, P = 0.0013). The IPTW-adjusted Fine-Gray regression model revealed that the mean PC2 (hazard ratio, 0.22; P < 0.001) and PC3 (hazard ratio, 0.24; P = 0.009) of the four levels were independent predictors of complete AR. In AAD repair, the AR rate was significantly higher with use of the FET than cET. The shape patterns of the residual TL can be an important reference for predicting postoperative AR.

Redo aortic arch repair using trifurcated hybrid prosthesis after failed Ascyrus medical dissection stent treatment

BackgroundThe management of acute type A aortic dissection (ATAAD) using the Ascyrus Medical Dissection Stent (AMDS) can lead to complications due to the persistence of the false lumen (FL). This case report presents two instances of failed AMDS treatment for ATAAD, highlighting the novel use of a trifurcated hybrid prosthesis for redo aortic arch repair using a minimally invasive frozen elephant trunk (FET) technique.Case PresentationCase 1: A 57-year-old male, previously treated with AMDS for ATAAD, presented with an enlarging aortic arch and persistent FL two years post-surgery caused by re-entry in the distal aortic arch. Redo surgery using the FET technique with an E-vita OPEN NEO Trifurcated hybrid prosthesis resulted in successful repair and partial FL thrombosis. Case 2: A 51-year-old male with prior AMDS treatment for ATAAD presented with severe aortic valve regurgitation and a maintained FL perfusion due to a residual re-entry in the proximal region of the descending aorta. Redo surgery using the FET technique with the same hybrid prosthesis led to successful repair and good recovery, confirmed by follow-up imaging.ConclusionsThe use of the E-vita OPEN NEO Trifurcated hybrid prosthesis in the FET technique offers a promising solution for redo aortic arch repair in cases of failed AMDS treatment for ATAAD. This approach can improve patient outcomes by addressing complications associated with persistent FL and enhancing long-term survival.

Long-term outcomes of frozen elephant trunk for aortic dissection: a single-center experience

BackgroundTo date a number of papers analysing outcomes of the frozen elephant trunk (FET) in acute aortic dissection has been published. However, there are limited comparative studies on long-term outcomes of FET in acute and chronic aortic dissection. The objective of the study was to analyze the long-term outcomes after FET procedure for aortic dissection (AD).MethodsBetween March 2012 and December 2022, a total of 123 FET had been performed for thoracic aortic disease. Patients with aortic dissection (n = 97) were divided into 2 groups: acute (n = 32, 33%) and chronic aortic dissection (n = 65, 67%). Pre-, intra- and postoperative data were retrospectively collected from electronic patient’s records, including follow-up data of the analyzed patients.ResultsThe incidence of stroke was 3.1%. The delirium rate was up to 9.3% in both groups with a prevalence in chronic aortic dissection (CAD) group without significant differences (P = 0.494). Paraplegia was diagnosed only in CAD patients (n = 2). Respiratory failure and the rate of renal replacement therapy were similar in the studied groups. Re-sternotomy was required in one (3.1%) patient with acute AD and 5 (7.7%) patients with chronic AD (P = 0.416). Overall 30-day mortality in the entire cohort, acute and chronic AD was 13 (13.4%), 7 (21.9%) and 6 (9.2%), respectively (P = 0.097). The overall survival rate at 60 months for the entire cohort, acute and chronic AD was 64.1 ± 5.9%, 62.3 ± 9.1%, 66.5 ± 7%, respectively (P = 0.265). Freedom from unintended distal aortic re-intervention at 60 months for the entire cohort of patients, acute and chronic AD was 74.2 ± 1.5%, 100%, 65.3 ± 2%, respectively (P = 0.355).ConclusionsOur experience showed acceptable long-term outcomes after the FET procedure including mortality and re-intervention rate in patients with aortic dissection regardless of acuity of the dissection.Trial registrationThe study has been registered in Australian and New Zealand Clinical Trial Registry (ACTRN 12618001329257) on August 7, 2018.

Outcomes of hand-made versus commercial stent grafts in frozen elephant trunk.

The frozen elephant trunk (FET) technique is effective for treating extended aortic arch aneurysms. This study compares hand-made and factory-made devices in this context. A retrospective case-control study was conducted on 68 patients who underwent FET for distal aortic arch aneurysm at our institution. We used two different types of devices: hand-made stent graft in group Z (17 cases, 25.0%) and a commercialized stent graft in group J (51 cases, 75.0%). The study compared demographic characteristics and the outcomes between the two groups. In-hospital mortality was equivalent in both groups (5.9%). Spinal cord injury rates were 5.9% in group Z and 3.9% in group J. Group Z had a higher rate of aortic events (55.9% vs 96.9%, p < 0.001) and more frequent stent migration. The number of cases with aneurysm diameter shrinkage was lower in group Z. The landing zone angle at insertion influenced aneurysm changes, being 17.6 degrees in shrink cases and 26.7 degrees in unchanged or enlarged cases (p = 0.045). FROZENIX device notably reduced incidences of postoperative complications compared to hand-made prostheses. Factors such as insertion angle and stent size, rather than changes in the landing zone angle, appeared to influence aneurysm shrinkage. The use of FROZENIX in TARFET procedures has shown benefits in reducing complications and improving long-term prognosis, taking into account the landing zone angle.

Correlation Between Intraoperative Near-infrared Spectroscopy Values and Neurologic Outcomes in Patients Undergoing Total Aortic Arch Replacement Using the Frozen Elephant Trunk Technique

ObjectiveTo correlate intraoperative near-infrared-spectroscopy (NIRS) values to neurologic outcome in patients undergoing total aortic arch replacement using the frozen elephant trunk (FET) technique. DesignRetrospective, single centre registry study using a two-way repeated measures ANOVA. SettingBetween 11/2013 and 12/2023, 427 patients were treated for acute and chronic aortic pathologies using FET procedure. ParticipantsOne-hundred sixty-six patients who had complete NIRS data at all predefined timepoints were included and retrospectively divided into two groups: patients with stroke diagnosed by experienced radiologists and clinicians and patients without stroke after FET. MeasurementsBilateral NIRS values were recorded continuously and at seven critical timepoints in each patient a correlation was made between left- and right-sided NIRS values and stroke. Main Results23 patients (13.9%) were diagnosed with a stroke. There was a significantly higher in-hospital mortality in patients with stroke (21.7%) compared to patients without stroke (7.7%) (p = 0.037). Left sided regional cerebral oxygenation (rSO2) did not show any significant difference in patients with stroke versus patients without stroke (p = 0.550). There were differences detected in right sided rSO2 trends (p < 0.001) and the inter-hemisphere NIRS at the specified timepoints (p = 0.009). The interaction Time x Stroke, however, did not show any significant results in all our analyses (p > 0.05). ConclusionNIRS is a reliable tool to monitor intraoperative frontal lobe cerebral oxygen saturation. However, its use to predict postoperative stroke remains limited. Further refinements are needed to develop the technique to a prediction tool.

Echocardiographic Evaluation of Cardiac Remodeling after FET

Abstract Background This study aimed to investigate if frozen elephant trunk (FET) implantation leads to negative cardiac remodeling in dissection and non-dissection patients and to determine whether there are differences when FET is implanted as an aortic redo procedure or initially. Methods Between March 2013 and April 2022, 148 patients received FET without any concomitant procedures and therefore formed our cohort. One hundred and four were treated for dissecting and 44 for non-dissecting pathologies. Eighty-four received FET initially and 64 as an aortic redo procedure. Data were collected retrospectively using our center's dedicated aortic database as well as transthoracic echocardiographic reports of our cardiologists. Results In the first weeks after FET implantation, dissection and non-dissection patients show a significant increase of mild valvular insufficiencies—a significant decrease of ejection fraction is only seen in dissection patients but these changes do not stay significant during later follow-up. Patients who receive FET as an aortic redo procedure tend to have significantly larger left ventricular (LV) end-diastolic diameters and higher LV masses, however, in longitudinal analysis, there were no long-term negative effects in patients who received FET initially or as aortic redo. Conclusion In the first 2 years after implantation, FET has no echocardiographically measurable effect regarding negative cardiac remodeling in dissection and non-dissection patients, independent of the fact it is implanted initially or as an aortic redo procedure.

Next-Generation Frozen Elephant Trunk Technique in the Era of Precision Medicine.

The frozen elephant trunk (FET) technique can be applied to extensive aortic pathology, including lesions in the aortic arch and proximal descending thoracic aorta. FET is useful for tear-oriented surgery in dissections, managing malperfusion syndrome, and promoting positive aortic remodeling. Despite these benefits, complications such as distal stent-induced new entry and spinal cord ischemia can pose serious problems with the FET technique. To prevent these complications, careful sizing and planning of the FET are crucial. Additionally, since the FET technique involves total arch replacement, meticulous surgical skills are essential, particularly for young surgeons. In this article, we propose several techniques to simplify surgical procedures, which may lead to better outcomes for patients with extensive aortic pathology. In the era of precision medicine, the next-generation FET device could facilitate the treatment of complex aortic diseases through a patient-tailored approach.

Optimal size of Frozenix for true thoracic aneurysms: is downsizing an option?

During total arch replacement (TAR) using frozen elephant trunk (FET) technique with Frozenix for true thoracic aortic aneurysm (tTAA), oversized FET tends to be chosen similar to the endovascular devise selection. However, the oversized FET is considered a risk factor for intimal injury. The appropriate size selection of FET remains insufficiently understood. Between October 2014 and March 2022, a total of 49 patients underwent TAR using Frozenix for tTAA. Out of 49 patients, four patients planned to staged surgery were excluded, 19 patients were operated on with an undersized Frozenix compared with the descending aorta (undersized FET group) and in 26 patients an equal or oversized Frozenix was used (oversized FET group). Clinical outcomes and postoperative diameter changes were investigated. In-hospital mortality was 0%. The mean diameter of Frozenix and the descending aorta was 30.7mm and 28.8mm, respectively, in the oversized FET group, and 26.7mm and 30.1mm in the undersized FET group. Postoperative computed tomography (CT) demonstrated no endoleaks not only in the oversized FET group but also in the undersized FET group. CT also revealed that undersized FET had expanded more than the original diameter in all cases except for two, with an average of 2.47 ± 1.53mm. Additionally, the descending aorta covered with Frozenix shrank in 10 patients (53%). Postoperative adverse aortic events were not observed. Undersized Frozenix tightly fit the descending aorta and resulted in complete sealing without endoleaks. Oversized FET is not strictly necessary considering the size-related adverse complications.

Short-term outcomes of mild (≥30 ℃) vs. moderate hypothermic circulatory arrest in aortic arch surgery.

Hypothermia and antegrade cerebral perfusion (ACP) strategies in open aortic arch surgery (AAS) have improved significantly. The significance of the gradual temperature rise to mild hypothermia is quite apparent, however, its safety remains a challenge. Therefore, our objective was to explore the safety and efficacy of mild hypothermic circulatory arrest (Mi-HCA, ≥30 ℃). This retrospective cohort study enrolled in a total of 372 patients, and was performed at the Beijing Anzhen Hospital between January 2017 and November 2022. Among the 372 patients, 81 received AAS at ≥30 ℃, and the remaining 291 received the same at 22-29.9 ℃. Most acute type A aortic dissection (ATAAD) patients received total arch replacement (TAR) and frozen elephant trunk (FET) operation. Mi-HCA patients exhibited strongly augmented systemic temperature (26.19±1.63 vs. 31.40±0.79 ℃, P<0.01). The surgical, cardiopulmonary bypass (CPB), cross-clamp, circulatory arrest, and ACP durations were drastically diminished among Mi-HCA patients (all P<0.01). Moreover, the major adverse events (MAEs) incidence of Mi-HCA patients was significantly decreased (25.43% vs. 14.81%, P<0.05). Simultaneously, the Mi-HCA strategy also exhibited enhanced protection of blood cells, as well as myocardial and hepatic function. Nevertheless, multivariate logistic regression analysis revealed that Mi-HCA strategy (≥30 ℃) was not a stand-alone risk factor for MAEs following AAS. The short-term outcomes and safety of Mi-HCA, in combination with ACP, in AAS are satisfactory. Additionally, relative to the traditional moderate hypothermic circulatory arrest (MHCA) approach, it can substantially decrease operation duration while improving patient clinical outcomes.

Distal Repair After Total Aortic Arch Replacement With Frozen Elephant Trunk in Patients With Chronic Multilevel Thoracic Aortic Disease

Distal Repair After Total Aortic Arch Replacement With Frozen Elephant Trunk in Patients With Chronic Multilevel Thoracic Aortic Disease

Systematic Review and Meta-Analysis With Reconstructed Time-To-Event Data of Frozen Elephant Trunk and Conventional Aortic Repair.

Frozen elephant trunk (FET) has gained popularity since its inception. Nevertheless, the optimal approach for managing aortic arch pathologies remains subject of debate. This meta-analysis compared outcomes between patients undergoing FET and those undergoing conventional aortic repair. Systematic searches were conducted up to February 2024. Pooled results of short and long-term outcomes were computed. A systematic review identified 21 non-randomized studies encompassing 3240 patients. Short-term mortality was lower in FET recipients than in those undergoing conventional repair (OR [95% CI] = 0.58 [0.44-0.78], P < .01). Postoperative paraplegia incidence was higher in the FET cohort (OR = 1.85 [1.02-3.34], P = .04), while subgroup analysis showed no difference between the two groups in patients with acute aortic dissection. Long-term all-cause mortality was lower among FET recipients. Subgroup analysis showed FET was associated with reduced all-cause mortality (HR = 0.55 [0.39-0.79], P < .01) and aortic re-intervention (HR = 0.62 [0.39-0.99], P = .05) in acute aortic dissection patients. This meta-analysis underscores the favorable association between the utilization of FET and improved short and long-term outcomes compared with conventional repair, while paraplegia incidence was higher in the FET group. FET appears to offer superior benefits, particularly evident in patients with acute aortic dissection.

The frozen elephant trunk technique in acute aortic dissection: the ultimate solution? An institutional experience.

Acute aortic dissection remains a serious emergency in the field of cardiovascular medicine and a challenge for cardiothoracic surgeons. In the present study, we seek to compare the outcomes of different surgical techniques in the repair of type A acute aortic dissection. Between April 2015 and May 2023, 213 patients (82 women, aged: 63.9 ± 13.3 years) with acute aortic dissection (205 type A and 8 non-A-non-B dissections) underwent surgical treatment in our department. A total of 45 patients were treated with the frozen elephant trunk (FET) technique supported by the Thoraflex™ Hybrid prosthesis, 33 received total aortic arch replacement (TAR)-standard or conventional elephant trunk-treatment, and 135 were treated with hemiarch replacement (HR). Aortic arch surgery was performed in most patients under moderate hypothermic (28°C on average) circulatory arrest, with selective antegrade cerebral perfusion through the right axillary artery. The rates of early mortality were 17.8% (38 perioperative deaths) in the whole population, 8.9% in the FET group of patients, and 33% and 17% in the TAR and HR group of patients, respectively (P-value 0.025). The rate of spinal cord injury was 2.3% (five patients), and a paresis of recurrent laryngeal occurred in 3.7% of patients (seven patients, four were treated with FET). Permanent neurological dysfunction occurred in 27 patients (12.7%). After a mean follow-up of 3 years, the rate of mid-term mortality of discharged patients was 19.4% (34 deaths: 7 FET, 4 TAR, and 23 HR) and the overall mortality rate was 33.8% [72 deaths: 11 FET (24.4%); 15 TAR (45.4%); 46 HR (34.1%)]. A total of 8 patients (17.8%) in whom FET was applied received additional endovascular treatment in the descending aorta. In our institutional experience, we found that the frozen elephant trunk technique with a high-end Thoraflex Hybrid prosthesis proved its surgical suitability in the treatment of acute aortic dissection with favorable outcomes. The FET technique and our perioperative management led to comparable neurological outcomes and reduced mortality rates in these emergency cases.

Frozen Elephant Trunk Procedure for Acute Type a Aortic Dissection: Analysis of Distal Aortic Remodeling According to the Society for Vascular Surgery (SVS)/Society of Thoracic Surgeons (STS) Reporting Standard

ObjectiveTo investigate impact of Frozen Elephant Trunk (FET) on long-term distal aortic remodelling in acute AAD according to the latest recommended standards from the Society for Vascular Surgery (SVS)/Society of Thoracic Surgeons (STS). MethodsClinical data and imaging of patients undergone FET to treat acute AAD over the last 8 years were retrospectively reviewed. Patients were included if a pre- and post-operative Computed AngioTomographies at least 30-day from surgery was available for comparison. Contrasted postprocessed imaging were analysed with Aquarius iNtuition (TeraRecon Inc., Foster City, CA, USA) to analyse long-term positive aortic remodelling, FL thrombosis and aortic expansion according to the SVS/STS recommendations. Secondary endpoints were the rate of in-hospital and long-term mortality, spinal cord ischaemia and aortic-related reinterventions. ResultsOut of 75 patients who underwent FET for type A AAD, n=41(54.6%) were included. Significant positive aortic remodelling was reported in Ishimaru zone 1-4 but not in visceral/infrarenal aorta (p<0.001) and overall rate of FL thrombosis was 95.1% (n=39). Aortic expansion rates were: 4.9% in zones 1-4, 8.3% in zones 5-6 and 15% in zone 7. The rates of in-hospital mortality and long-term mortality were 7.3% (n=3) and 9.7% (n=4) respectively. At a median follow-up of 11 months (range 1-141, reintervention rate was 17.1%. ConclusionsWe report positive aortic remodelling of the distal thoracic aorta in patients who underwent FET for acute AAD according to the SVS/STS reporting standards. The positive effect on the distal aorta is limited to the thoracic segments but not in the visceral aorta.

Surgical Strategies in Reoperation of the Proximal Aorta and Arch for Patients with Previous Frozen Elephant Trunk.

Background: The frozen elephant trunk (FET) technique is increasingly utilized for aortic arch replacement in cases of aortic dissections and aneurysms. This rise in usage has led to more patients needing redo aortic surgeries due to progression of existing conditions, FET-related complications, or new valvular/coronary diseases. This article aims to evaluate surgical techniques to minimize risks during these reoperations, including a case study of a complex redo surgery. Methods: A comprehensive examination of surgical strategies was conducted, focusing on preoperative preparation, cannulation site identification, cerebral and cardiac protective measures, and pitfalls to avoid. The importance of adapting to the modified anatomical landscape post-FET is emphasized. A detailed case study of a patient undergoing complex redo FET surgery is included. Results: The article identified key surgical strategies for reoperation in patients with prior FET, highlighting the importance of meticulous preoperative planning and execution. Techniques to minimize risks include detailed imaging for planning, strategic cannulation for optimal perfusion, multidisciplinary approaches as well as careful fail-safe measures. The case study demonstrates the practical application of these strategies in a high-risk scenario. The evidence underscores the necessity for individualized patient management and the development of standardized protocols. Conclusions: The FET technique, while effective for initial aortic arch repairs, often necessitates complex reoperations. Adopting advanced surgical strategies and multidisciplinary planning can significantly mitigate risks associated with these procedures. Future research should focus on refining these techniques and establishing standardized protocols to improve patient outcomes.

Paraplegie na ‘frozen elephant trunk’-chirurgie: een casus

Paraplegia after frozen elephant trunk surgery In contrast to surgery of the thoracoabdominal aorta, the complication of paraplegia due to spinal cord ischemia after a frozen elephant trunk procedure is less well-known. The aim of this case report is to carry this knowledge beyond the borders of the cardiac speciality. The deployment of the prosthesis, the induction of a circulatory arrest, perioperative hypotension, hypoxemia and reperfusion injury jeopardize the spinal blood flow. A ground understanding of the pathogenesis is a must for implementing adequate perioperative management guidelines to minimize the risk of this feared complication.