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

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

“…There are 2 other commercially available FETs: the Cronus (MicroPort, Shanghai, China) and the J graft (now Frozenix) (Japan Lifeline, Tokyo, Japan). 157,158 The FET is potentially indicated for all pathologies of the aortic arch, aneurysm and dissection. 159e161 Different from endovascular aortic repair, the fixation of the FET is performed by a circumferential suture, which eliminates the risk of a proximal endoleak.…”

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 .…”

“…Currently, the frozen elephant trunk (FET) technique is gaining popularity. Total arch replacement (TAR) using FET technique is a hybrid procedure comprising open surgery and stent‐graft placement for various thoracic aortic pathologies . FROZENIX (Japan Lifeline, Tokyo, Japan) (Figure ) is the first commercialized open stent‐graft (OSG) in Japan, and it is a useful alternative to previously used self‐made OSGs .…”

The Frozen Elephant Trunk Technique: European Association for Cardio-Thoracic Surgery Position and Bologna Experience

“…Until December 2014, more than 28,000 hybrid prostheses were implanted worldwide [ 5 ]. Due to the great interest in the FET technique, the Vascular Domain of the European Association for Cardio-thoracic Surgery (EACTS) felt the need to write a position paper in which, with the help of other experienced aortic surgeons, the current knowledge and the state of the art regarding the FET technique were presented [ 6 ].…”