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Review
. 2022 Aug;37(8):2397-2407.
doi: 10.1111/jocs.16596. Epub 2022 May 8.

The great vessel freeze-out: A meta-analysis of conventional versus frozen elephant trunks in aortic arch surgery

Nicholas A Vernice  1 , Matthew E Wingo  1 , Paul B Walker  1 , Michelle Demetres  2 , Lily N Stalter  3 , Qiuyu Yang  3 , Andreas R de Biasi  4
Affiliations
Review

The great vessel freeze-out: A meta-analysis of conventional versus frozen elephant trunks in aortic arch surgery

Nicholas A Vernice et al. J Card Surg. 2022 Aug.

Abstract

Background: The optimal treatment strategy for complex aortic arch and proximal descending aortic pathologies remains controversial. Despite the frozen elephant trunk (FET) technique's increasing popularity, its use over the conventional elephant trunk (CET) remains a matter of physician preference and outcomes are varied.

Methods: This meta-analysis of available comparative studies of FET versus CET sought to examine differences in survival, reintervention, and adverse events. The following databases were searched from inception-May 2020: Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria with a protocol registered on Open Science Framework at https://osf.io/hrfze/.

Results: The search identified 1911 citations, with five studies included. The resultant meta-analysis included 313 CET and 292 FET cases. FET had lower perioperative mortality (risk ratio [RR]: 0.50, 95% confidence interval [CI]: [0.42; 0.60], p < .001) and improved 1-year survival compared to CET (hazard ratio: 0.63, 95% CI: [0.42; 0.95], p = .03). There were no significant differences in rates of overall or open reinterventions following FET versus CET, but FET did yield a significantly higher rate of endovascular reintervention (RR: 2.32, 95% CI: [1.17; 4.61], p = .03). No significant differences were observed in the incidences of postoperative stroke, spinal cord injury, or renal failure between groups.

Conclusions: The FET technique yields superior rates of perioperative and medium-term survival with no significant increase in overall reinterventions. There was no significant difference in the rate of spinal cord injury between groups, providing further large-scale evidence that the FET is an acceptable, safe alternative to the CET.

Keywords: aortic arch; elephant trunk; frozen elephant trunk; reintervention.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flow diagram. PRISMA flow diagram outlining the process of study identification and selection.
Figure 2
Figure 2
Forest plot for 1‐year survival. Forest plot demonstrating variable heterogeneity. CI, confidence interval; df, degrees of freedom; IV, inverse variance.
Figure 3
Figure 3
Forest plot for reintervention rates. (A) Forest plot demonstrating variable heterogeneity for open reintervention. (B) Forest plot for overall reintervention. (C) Forest plot for endovascular reintervention. CI, confidence interval; df, degrees of freedom; MH, Mantel–Haenszel test.
Figure 4
Figure 4
Forest plot for perioperative mortality. Forest plot demonstrating variable heterogeneity. CI, confidence interval; df, degrees of freedom; MH, Mantel–Haenszel test.
Figure 5
Figure 5
Forest plots for adverse events. (A) Forest plot demonstrating variable heterogeneity for stroke. (B) Forest plot for spinal cord injury. (C) Forest plot for renal failure. CI, confidence interval; df, degrees of freedom; MH, Mantel–Haenszel test.
See this image and copyright information in PMC

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