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Abstract

Background

The frozen elephant trunk (FET) procedure is developed to treat complex aortic arch diseases. We aimed to share our single centre experience of FET operations over time.

Methods

A review of first 100 patients who underwent FET procedures for acute, chronic dissection and thoracic aneurysm from January 2016 to January 2024. The patients were divided into two groups: Group 1 (first 50 cases); Group 2 (subsequent 50 cases) and compared the early and late outcomes.

Results

Early overall mortality was 9% but reduced with time {12% (6/50) in Group 1 vs. 6% (3/50) in Group 2, p = 0.295} with no deaths among the isolated FET procedures. Morbidity included stroke (4%), spinal cord injury (3%) and temporary renal dialysis (9%). Durations of total operation time, cross clamp, circulatory arrest and cerebral perfusion were shorter in group 2; p < 0.05. Concomitant coronary artery bypass grafting, clamp time >180 min, temperature <20 °C and ventilation >72 h were the significant risk factors for all mortality. The overall 1, 5 and 7-year survival were 93.8, 90.7 and 82.5%, respectively, with freedom from aortic re-intervention reflected at 98.8, 87.8 and 87.8%, accordingly.

Conclusions

Early mortality for FET procedure was significantly reduced to 6% with time and no death among isolated FET. The FET operations became faster with better recovery. Doing more cases, refining surgical techniques and post-operative care are the lessons learned for improvements.

Keywords

Frozen elephant trunk aortic arch thoracic aortic aneurysm aortic dissection

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Single centre Asian experience of first 100 cases of frozen elephant trunk procedures: Humble beginning,evolution and lessons learned