{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T07:20:55Z","timestamp":1765610455334,"version":"3.41.2"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T00:00:00Z","timestamp":1713139200000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The frozen elephant trunk (FET) technique as a hybrid combining surgical and endovascular repair is an emerging concept to treat complex aortic dissection. Early experience showed technical feasibility and promising clinical outcomes. However, unsuspected complications still arise.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 25-year-old male presented to the emergency department with a 2-day history of chest pain. After exclusion of acute coronary syndrome, a computed tomography angiography (CTA) revealed Type A (DeBakey Type I) aortic dissection. The patient underwent median stenotomy for complete replacement of the ascending aorta, the aortic arch, and FET. Early after rewarming, the patient became unstable due to severe left ventricular dysfunction. Soon veno-arterial extracorporal membrane oxygenation (VA-ECMO) was required for circulatory support. The cause of deterioration remained unclear until repeated CTA showed acute obstruction of the FET. Invasive exploration confirmed a trans-FET gradient of 100\u2005mmHg, successfully managed by repeated balloon inflation with resolution of both obstruction and gradient. The patient recovered completely without any sequela.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>While the mechanism of acute obstruction after FET remains subject to speculation, the rescue intervention of ballooning the obliteration on VA-ECMO was life-saving. Intraoperative ultrasound and videoscopic inspection may be instrumental before chest closure to avoid such critical events.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae186","type":"journal-article","created":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T17:40:44Z","timestamp":1713202844000},"source":"Crossref","is-referenced-by-count":2,"title":["The elephant\u2019s Achilles\u2019 heel: a case report of acute obstruction of frozen elephant trunk after proximal aortic dissection repair"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5779-7549","authenticated-orcid":false,"given":"Stephan","family":"Nienaber","sequence":"first","affiliation":[{"name":"University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine , Cologne , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6843-6466","authenticated-orcid":false,"given":"Xun","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Aortic Centre, Guy\u2019s and St. Thomas\u2019 Hospitals NHS Trust, Royal Brompton and Harefield Hospitals , London SW3 6NP , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6425-3360","authenticated-orcid":false,"given":"Susanna","family":"Price","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Aortic Centre, Guy\u2019s and St. Thomas\u2019 Hospitals NHS Trust, Royal Brompton and Harefield Hospitals , London SW3 6NP , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich","family":"Rosendahl","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Aortic Centre, Guy\u2019s and St. Thomas\u2019 Hospitals NHS Trust, Royal Brompton and Harefield Hospitals , London SW3 6NP , UK"},{"name":"Department of Cardiac Surgery, Guy\u2019s and St. Thomas\u2019 Hospitals NHS Trust, Royal Brompton and Harefield Hospitals , London , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9671-8030","authenticated-orcid":false,"given":"Christoph A","family":"Nienaber","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Aortic Centre, Guy\u2019s and St. Thomas\u2019 Hospitals NHS Trust, Royal Brompton and Harefield Hospitals , London SW3 6NP , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,4,15]]},"reference":[{"key":"2024043013452993500_ytae186-B1","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1093\/ejcts\/ezv085","article-title":"Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS","volume":"47","author":"Shrestha","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024043013452993500_ytae186-B2","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.jtcvs.2019.03.121","article-title":"Total aortic arch replacement with frozen elephant trunk technique: results from two European institutes","volume":"159","author":"Leone","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024043013452993500_ytae186-B3","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S0140-6736(22)01970-5","article-title":"Acute aortic dissection","volume":"401","author":"Carrel","year":"2023","journal-title":"Lancet"},{"key":"2024043013452993500_ytae186-B4","doi-asserted-by":"crossref","first-page":"912071","DOI":"10.3389\/fcvm.2022.912071","article-title":"Kinking of frozen elephant trunk hybrid prostheses: incidence, mechanism, and management","volume":"9","author":"Kayali","year":"2022","journal-title":"Front Cardiovasc 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Surg"},{"key":"2024043013452993500_ytae186-B8","first-page":"633","article-title":"Trade in the hammer for a power driver\u2014perspectives on the frozen elephant trunk repair for aortic arch disease","volume":"2","author":"Roselli","year":"2013","journal-title":"Ann Cardiothorac Surg"},{"key":"2024043013452993500_ytae186-B9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.21037\/acs-2020-fet-22","article-title":"Hybrid arch frozen elephant trunk repair: evidence from the Canadian Thoracic Aortic Collaborative","volume":"9","author":"Ouzounian","year":"2020","journal-title":"Ann Cardiothorac Surg"}],"container-title":["European Heart Journal - Case 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