Clinical outcomes of the Frozen Elephant Trunk procedure in 70 emergent and elective patients undergoing aortic arch surgery: the Salerno experience with Thoraflex Hybrid

Background: and aim of the study. To report early clinical outcomes of the frozen elephant trunk technique (FET) for the treatment of complex aortic diseases after transition from conventional elephant trunk. Methods. A single-center, retrospective study of patients who underwent hybrid aortic arch and FET repair for aortic arch and/or proximal descending aortic aneurysms, acute and chronic Stanford type A aortic dissection with arch and/or proximal descending involvement, Stanford type B acute and chronic aortic dissections with retrograde aortic arch involvement. Results. Between December 2017 and May 2020, 70 consecutive patients (62.7±10.6 years, 59 male) were treated: 41 (58.6%) for acute conditions and 29 (41.4%) for chronic. Technical success was 100%. In-hospital mortality was 14.2% (n=12, 17.1% emergency vs. 10.3% chronic, P=NS); 2 (2.9%) major strokes; 1 (1.4%) spinal cord injury. Follow-up was 12.5 months (IQR 3.7—22.3. Overall survival at 3, 6, 12 and 24 months was 90% (95% CI, 83.2—97.3), 85.6% (95% CI, 77.7—94.3), 79.1% (95% CI, 69.9—89.5), 75.6% (95% CI, 65.8—86.9) and 73.5 (95% CI, 63.3—85.3). There were no aortic re-interventions and no dSINE; 5 patients with residual type B dissection underwent TEVAR completion. Conclusions. In a real-world setting, FET demonstrated a rapid learning curve and good clinical outcomes, even in acute type A aortic dissections. Techniques to perfect the procedure and to reduce remaining risks, and consensus on considerations such as standardized cerebral protection need to be reported.