Open Stented Grafts for Frozen Elephant Trunk Technique: Technical Aspects and Current Outcomes

Abstract

With growing experience in patients with aneurysms and dissections in the arch and proximal descending aorta, the frozen elephant trunk (FET) technique has been shown to be safe and effective, and has achieved favorable short to mid-term outcomes. As the FET technique is gaining wider acceptance, there is a growing need for versatile, technically simple, and highly durable open stented grafts involving less complicated deployment mechanisms enabling use in various indications. This paper gives a brief review on the technical aspects and clinical outcomes of currently available open stented grafts used in the FET technique, including the E-vita Open Plus, Thoraflex Hybrid, Cronus, and J Graft. While none of these grafts can claim to be an ideal device, technology continues to improve towards this goal. As newer devices and systems are developed, more widespread use of the FET technique can be expected; such progress promises to improve the clinical outcomes and quality of life for patients with complex aortic diseases. With growing experience in patients with aneurysms and dissections of the arch and proximal descending aorta, the FET technique has been shown to be safe and effective, with favorable early and long-term outcomes [16][17][18][19][20][21][22][23][24]. Accordingly, the FET technique is gaining wider acceptance among the cardiovascular surgical community, resulting

Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome

“…This approach may at least eliminate the need for an additional operation on the arch and proximal DA via a repeat median sternotomy in some patients. In addition, the Cronus FET has an extra centimeter of Dacron sewing cuff at the distal end, which facilitates manipulations during second-stage repair or reoperations should this be required (37).…”

Unexpected intraoperative obstruction of frozen elephant trunk in patients who underwent total arch replacement

“…The FET technique is widely practiced and has played an important role in the surgical treatment of various thoracic aortic pathologies. TAR using the FET technique is safe and effective, with favorable early and long‐term outcomes . Although the commercially available FETs formerly launched in the European market are designed to treat extensive thoracic aortic diseases, their deployment seems to be complex, time‐consuming, and technically demanding .…”

“…TAR using the FET technique is safe and effective, with favorable early and long‐term outcomes . Although the commercially available FETs formerly launched in the European market are designed to treat extensive thoracic aortic diseases, their deployment seems to be complex, time‐consuming, and technically demanding . FROZENIX has been available since 2014 in Japan .…”

“…TAR using the FET technique is safe and effective, with favorable early and long-term outcomes. 1,2 Although the commercially This new device comprises a distal stented segment and a proximal nonstented segment. FROZENIX has a simple structure and enables easier deployment; therefore, its deployment was considered technically less demanding than the previously launched FETs.…”

“…Total arch replacement (TAR) using FET technique is a hybrid procedure comprising open surgery and stent-graft placement for various thoracic aortic pathologies. 1,2 FROZENIX (Japan Lifeline, Tokyo, Japan) ( Figure 1) is the first commercialized open stent-graft (OSG) in Japan, and it is a useful alternative to previously used selfmade OSGs. 2 FROZENIX is easy to deploy compared with other commercially available OSGs.…”