Shao-Wei Chen
Current Position
Linkou Chang Gung Memorial Hospital
Thoracic Aorta Session

Topic: The Frozen Elephant Trunk in Acute and Chronic Aortic Dissection


(1) Acute type A aortic dissection is associated with relatively high operative
mortality despite advances in the past decades.
The frozen elephant trunk (FET) technique is a valuable adjunct to total arch replacement in patients with distal aortic malperfusion with compression of the true lumen, complex primary and reentry tears, or rupture involving the distal arch or proximal descending thoracic aorta (DTA). In patients with malperfusion, FET can fully open the compressed true lumen and cover additional entry tears in the proximal DTA, which maintain false lumen pressurization. Taking advantage of the distal stent graft segment of the FET prosthesis, distal anastomosis can be performed more easily at a level that is proximal to the left subclavian or left carotid
arteries while excluding the distal arch tear.
We report our single institutional results of acute type A dissection repair with conservative tear-oriented approach. FET was only performed on patients selected by experienced aortic surgeons.
(2) Reoperative total arch replacement for chronic dissection with a previous proximal aortic repair carries high surgical risk. We report a debranching hybrid technique that minimized dissection of the mediastinal structures, integrating the arch-first technique, and simplified the distal anastomosis. A 5-cm conventional elephant trunk was constructed for adequate proximal landing of aortic stent, and FET (Gore TAG) was inserted through a transverse incision distally in the old grafts. Our technique enabled distal anastomosis proximalization, which minimized the risk of recurrent nerve injury, anastomotic site bleeding, cerebral deep hypothermic cardiac arrest, and myocardial ischemic time.