Frozen Elephant Trunk with Gore Thoracic Endovascular Graft and Quadrifurcate Graft

The frozen elephant trunk has simplified the surgical treatment of the entire thoracic aorta; moreover many different technical variants of how to do it have been described. Our procedure include implantation of a Gore CTAG graft into the aortic arch followed by a teflon reinforced suture line that should include the stent graft and the native aorta. The 4-branched graft is then sutured to the distal stump therefore creating a custom-made frozen elephant trunk hybrid prosthesis. Three patients with acute type A aortic dissection and primary entry tear in the arch were operated with this technique. There were no early or late deaths, moreover no neurologic events occurred. The purpose of this article is to introduce an innovative technique for total arch replacement with the combination of a Gore CTAG stent graft used as a frozen elephant trunk and a standard 4-branched graft for arch reconstruction.