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Review
. 2024 Sep 5;57(5):419-429.
doi: 10.5090/jcs.24.089.

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

Suk-Won Song  1 , Ha Lee  1 , Myeong Su Kim  1 , Randolph Hung Leung Wong  2 , Jacky Yan Kit Ho  2 , Wilson Y Szeto  3 , Heinz Jakob  4
Affiliations
Review

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

Suk-Won Song et al. J Chest Surg. .

Abstract

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.

Keywords: Aortic diseases; Endoleak; Endovascular aneurysm repair; Spinal cord ischemia; Vascular grafting.

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Conflict of interest statement

Conflict of interest

Suk-Won Song is an associate editor of the Journal of Chest Surgery but was not involved in the peer reviewer selection, evaluation, or decision process of this article. Except for that, no other potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Illustration of the E-vita OPEN NEO device as used in a repair of extensive aortic pathology. (A) In patients with acute aortic dissection (AAD), frozen elephant trunk (FET) aims to prevent proximal entry or re-entry tears. (B) In patients with chronic aortic dissection, FET aims not for a single-stage operation, but rather for functioning as a bridge to a second procedure. (C) In patients with thoracic aortic aneurysm, FET aims for complete sealing of the aneurysm in a single-stage operation, sometimes with additional thoracic endovascular aortic repair [27].
Fig. 2
Fig. 2
Stent graft diameter measurement in patients with acute aortic dissection [35].
Fig. 3
Fig. 3
Stent graft diameter measurement in patients with acute aortic dissection [35].
Fig. 4
Fig. 4
Stent graft diameter measurement in patients with acute aortic dissection [35].
Fig. 5
Fig. 5
Illustration and images of reinforcement suture technique at the distal anastomosis. (A) Reinforcement suturing over the continuous suture. (B) Completed reinforcement suture in all 360° of the collar. (C) Image of completed reinforcement sutures in the anterior portion. (D) Image of completed reinforcement sutures in the posterior portion. The asterisk (*) denotes the position of the plicated left subclavian artery os with zone 2 anastomosis [37].
Fig. 6
Fig. 6
Two distal springs inside the graft to prevent distal stent graft-induced new entry (distal SINE). Ø, diameter; L, length; W, width.
See this image and copyright information in PMC

References

    1. Carrel T, Sundt TM, 3rd, von Kodolitsch Y, Czerny M. Acute aortic dissection. Lancet. 2023;401:773–88. doi: 10.1016/S0140-6736(22)01970-5. https://doi.org/10.1016/S0140-6736(22)01970-5. - DOI - PubMed
    1. Vilacosta I, San Roman JA, di Bartolomeo R, et al. Acute aortic syndrome revisited: JACC state-of-the-art review. J Am Coll Cardiol. 2021;78:2106–25. doi: 10.1016/j.jacc.2021.09.022. https://doi.org/10.1016/j.jacc.2021.09.022. - DOI - PubMed
    1. Elefteriades JA, Farkas EA. Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. J Am Coll Cardiol. 2010;55:841–57. doi: 10.1016/j.jacc.2009.08.084. https://doi.org/10.1016/j.jacc.2009.08.084. - DOI - PubMed
    1. Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet. 2005;365:1577–89. doi: 10.1016/S0140-6736(05)66459-8. https://doi.org/10.1016/S0140-6736(05)66459-8. - DOI - PubMed
    1. Chou E, Pirruccello JP, Ellinor PT, Lindsay ME. Genetics and mechanisms of thoracic aortic disease. Nat Rev Cardiol. 2023;20:168–80. doi: 10.1038/s41569-022-00763-0. https://doi.org/10.1038/s41569-022-00763-0. - DOI - PubMed

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