Technical success and initial clinical outcome of partial frozen elephant trunk in various aortic arch pathology

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Abstract
Objective: This study aimed to investigate the operative and short-term clinical outcomes of total arch replacement using the partial frozen elephant trunk (FET) technique. Methods: Sixteen patients with aortic arch disease were treated with partial FET at six institutions between August and December 2023. The primary endpoint of our study was the technical success of partial FET implantation. The secondary endpoints included death and the occurrence of aortic events, such as the distal stent graft–induced new entry. Numerical values are presented as mean ± standard deviation. Results: The mean age of the patients was 62 ± 10 years, with eight being female. The indications for the operation included acute aortic dissection in 10 patients, chronic aortic dissection in 5, and anastomotic pseudoaneurysm in 1. Total arch replacement with partial FET was successfully performed on all patients. The duration of circulatory arrest, aortic cross-clamping, and cardiopulmonary bypass were 62 ± 17, 176 ± 66, and 271 ± 65 min, respectively. No symptomatic postoperative pressure gradient between the upper and lower extremities was observed. The 30-day and in-hospital mortality rates were both 0%. There were no cases of new postoperative stroke, paraplegia, or paraparesis. Additionally, no aorta-related complications were reported. An excellent surgical view of the distal unstented portion of the partial FET was achieved through left thoracotomy during the thoracoabdominal aortic replacement performed 3 months after the initial surgery. Conclusions: The clinical outcomes of total arch replacement using the partial FET technique were satisfactory. However, surgeons must exercise caution when employing this method for chronic aortic dissection due to its weak radial and spring back forces. Graphical

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