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Review
. 2013 Sep;2(5):581-91.
doi: 10.3978/j.issn.2225-319X.2013.09.07.

A systematic review and meta-analysis on the safety and efficacy of the frozen elephant trunk technique in aortic arch surgery

David H Tian  1 , Benjamin Wan, Marco Di Eusanio, Deborah Black, Tristan D Yan
Affiliations
Review

A systematic review and meta-analysis on the safety and efficacy of the frozen elephant trunk technique in aortic arch surgery

David H Tian et al. Ann Cardiothorac Surg. 2013 Sep.

Abstract

Background: The treatment of complex pathologies of the aortic arch and proximal descending aorta represents a significant challenge for cardiac surgeons. Various surgical techniques and prostheses have been implemented over the past several decades, all with varying degrees of success. The introduction of the frozen elephant trunk (FET) technique facilitates one-stage repair of such pathologies. The present systematic review and meta-analysis aims to assess the safety and efficacy of the FET approach in the current literature.

Methods: Electronic searches were performed using six databases from their inception to July 2013. Relevant studies utilizing the FET technique were identified. Data were extracted and analyzed according to predefined clinical endpoints.

Results: Seventeen studies were identified for inclusion for qualitative and quantitative analyses, all of which were observational reports. Pooled mortality was 8.3%, while stroke and spinal cord injuries were 4.9% and 5.1% respectively. Cardiopulmonary bypass time, myocardial ischemia time, and circulatory arrest time strongly correlated with perioperative mortality in a linear relationship, while moderate correlations between cerebral perfusion time and mortality, and circulatory arrest time and spinal cord injury, were also identified. Five-year survival, reported in five studies, ranged between 63-88%.

Conclusions: Overall, results of the present systematic review and meta-analysis suggest that the FET procedure can be performed with acceptable mortality and morbidity risks.

Keywords: Frozen elephant trunk; aortic dissection; hybrid procedure; systematic review; thoracic aneurysm.

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Figures

Figure 1
Figure 1
A frozen elephant trunk procedure
Figure 2
Figure 2
Search strategy of systematic review on aortic arch surgery utilizing frozen elephant trunk
Figure 3
Figure 3
Operative durations for studies utilizing the FET approach, including: A. Cardiopulmonary bypass time; B. Myocardial ischemic time; C. Circulatory arrest time; D. Cerebral perfusion time. Weighted average and standard deviations were calculated where statistically possible. Note: study reference inserted after study name
Figure 4
Figure 4
Bubble plot demonstrating significant strong positive correlation between mortality and A. Cardiopulmonary bypass time; B. Myocardial ischemia time and C. Visceral ischemia time, respectively; and no strong correlation with D. Cerebral perfusion time was observed. Diameter of the circles is proportional to the number of patients in the study. rs represents the strength of linear correlation between variables on the X and Y axis. rs ranges between –1 (strong negative correlation) and 1 (strong positive correlation). rs =0 indicates no correlation between two variables
See this image and copyright information in PMC

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