Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May;9(3):144-151.
doi: 10.21037/acs.2020.03.08.

Long-term outcomes of the frozen elephant trunk procedure: a systematic review

David H Tian  1   2 , Hakeem Ha  1 , Yashutosh Joshi  1 , Tristan D Yan  1   3
Affiliations

Long-term outcomes of the frozen elephant trunk procedure: a systematic review

David H Tian et al. Ann Cardiothorac Surg. 2020 May.

Abstract

Background: The frozen elephant trunk (FET) procedure remains an increasingly popular approach to address complex multi-segmental aortic pathologies, owing to their ability to promote false lumen thrombosis and reduce the need for second-stage operations. While the short-term outcomes of such procedures have been shown to be acceptable, much less is known regarding long-term outcomes. This systematic review evaluates long-term outcomes of the FET procedure.

Methods: Studies with at least 12 months follow-up data on FETs were identified in four electronic databases. All studies were reviewed by two independent researchers and relevant data extracted. Long-term outcomes, including overall survival, freedom from reintervention, and freedom from aortic events, were evaluated using patient data recreated from digitized Kaplan-Meier curves.

Results: Thirty-seven studies with 4,178 patients were identified. The majority of the studies focused solely on acute dissections. Average follow-up was 3.2 years. Overall survival at 1-, 3-, and 5-year was 89.6%, 85.2%, and 82.0%, respectively. Freedom from reintervention at the same timepoints were 93.9%, 89.3%, and 86.8%, respectively. Mortality, permanent neurological deficit and spinal cord injury were 10.2%, 7.7%, and 6.5%, respectively.

Conclusions: Survival after the FET procedure is favorable, though ongoing close serial monitoring is essential to assess for the need for further reintervention. Larger multi-institutional registries are required to provide more robust evidence to better elucidate the patient cohort that would most benefit from the FET.

Keywords: Frozen elephant trunk (FET); freedom from reintervention; stent-graft; survival; systematic review.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Overall survival. Dotted line represent expected survival of the general population, using the study mean age/gender as a reference.
Figure 2
Figure 2
Freedom from aortic events.
Figure 3
Figure 3
Freedom from reintervention.
Figure S1
Figure S1
PRIMSA flow chart of literature search.
See this image and copyright information in PMC

References

    1. Shrestha M, Martens A, Kaufeld T, et al. Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years. Eur J Cardiothorac Surg 2017;52:858-66. 10.1093/ejcts/ezx218 - DOI - PubMed
    1. Berger T, Kreibich M, Morlock J, et al. True-lumen and false-lumen diameter changes in the downstream aorta after frozen elephant trunk implantation. Eur J Cardiothorac Surg 2018;54:375-81. 10.1093/ejcts/ezy031 - DOI - PubMed
    1. Koullias GJ, Wheatley GH., 3rd State-of-the-art of hybrid procedures for the aortic arch: a meta-analysis. Ann Thorac Surg 2010;90:689-97. 10.1016/j.athoracsur.2009.12.016 - DOI - PubMed
    1. Tian DH, Wan B, Di Eusanio M, et al. Short- and medium-term outcomes of the frozen elephant trunk technique in aortic arch surgery: A systematic review. Heart, Lung and Circulation 2015;24:e58-9. 10.1016/j.hlc.2014.12.124 - DOI
    1. Lin HH, Liao SF, Wu CF, et al. Outcome of frozen elephant trunk technique for acute type A aortic dissection: as systematic review and meta-analysis. Medicine (Baltimore) 2015;94:e694. 10.1097/MD.0000000000000694 - DOI - PMC - PubMed