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. 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.

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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

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