{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T03:52:32Z","timestamp":1771300352075,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,2,20]],"date-time":"2022-02-20T00:00:00Z","timestamp":1645315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Ever since the first hybrid prosthesis was used for a total aortic arch replacement, many other techniques have been developed to comply with the need for the treatment of a wide spectrum of patients and their clinical pictures. We hereby provide an overview of the most popular surgical techniques to perform a frozen elephant trunk, including our tailored approach revolving around the antegrade deployment of a Gore C-TAG endovascular stent graft sutured to a four-branched vascular prosthesis. This technique was applied to three cases of acute type A aortic dissection. Although our small series of patients consists of acute aortic dissections only, this technique could be applied to any other aortic arch pathology, such as chronic dissections or aneurysms. Moreover, we believe that, because of the individually tailored approach and widespread availability of the necessary materials, this technique can reveal itself useful in many different operative scenarios.<\/jats:p>","DOI":"10.3390\/jcm11041120","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T08:22:19Z","timestamp":1645431739000},"page":"1120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Frozen Elephant Trunk: Technical Overview and Our Experience with a Patient-Tailored Approach"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5079-9330","authenticated-orcid":false,"given":"Alan","family":"Gallingani","sequence":"first","affiliation":[{"name":"Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy"},{"name":"Cardiac Surgery Unit, Angel Hospital, 30174 Mestre, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0080-7480","authenticated-orcid":false,"given":"Andrea","family":"Venturini","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Angel Hospital, 30174 Mestre, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Scarpanti","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Mangino","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Angel Hospital, 30174 Mestre, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3989-6134","authenticated-orcid":false,"given":"Francesco","family":"Formica","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy"},{"name":"Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1055\/s-2007-1020290","article-title":"Extensive aortic replacement using \u201celephant trunk\u201d prosthesis","volume":"31","author":"Borst","year":"1983","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1016\/S0022-5223(96)70157-5","article-title":"Stented elephant trunk procedure for an extensive aneurysm involving distal aort- ic arch and descending aorta","volume":"112","author":"Suto","year":"1996","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_3","first-page":"II188-93","article-title":"New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft","volume":"94","author":"Kato","year":"1996","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/S0022-5223(03)00045-X","article-title":"The frozen elephant trunk technique: A new treatment for thoracic aortic aneurysms","volume":"125","author":"Karck","year":"2003","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","first-page":"450","article-title":"Classification and outcomes of extended arch repair for acute Type A aortic dissection: A systematic review and meta-analysis","volume":"24","author":"Smith","year":"2017","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1093\/ejcts\/ezy313","article-title":"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) and the European Society for Vascular Surgery (ESVS)","volume":"55","author":"Czerny","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1093\/ejcts\/ezs296","article-title":"Total aortic arch replacement with a novel four-branched frozen elephant trunk graft: First-in-man results","volume":"43","author":"Shrestha","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_8","first-page":"766","article-title":"Development of an inte- grated stent graft-dacron prosthesis for intended one-stage repair in complex thoracic aortic disease","volume":"30","author":"Jakob","year":"2005","journal-title":"Herz-Kardiovaskulare Erkrankungen"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"122","DOI":"10.12945\/j.aorta.2015.14-062","article-title":"Open stented grafts for frozen elephant trunk technique: Technical aspects and current outcomes","volume":"3","author":"Ma","year":"2015","journal-title":"Aorta"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"368","DOI":"10.21037\/acs.2016.06.02","article-title":"Current surgical results of acute type A aortic dissection in Japan","volume":"5","author":"Okita","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.athoracsur.2010.04.040","article-title":"Antegrade delivery of stent grafts to treat complex thoracic aortic disease","volume":"90","author":"Roselli","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.1016\/j.athoracsur.2012.02.080","article-title":"Ascending, Total Arch, and Descending Thoracic Aortic Repair for Acute DeBakey Type I Aortic Dissection Without Circulatory Arrest","volume":"94","author":"Kent","year":"2012","journal-title":"Ann. Thorac. Surg."},{"key":"ref_13","first-page":"642","article-title":"Sun\u2019s procedure for complex aortic arch repair: Total arch replacement using a tetrafurcate graft with stented elephant trunk implantation","volume":"2","author":"Ma","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"152","DOI":"10.21037\/acs.2020.03.13","article-title":"Frozen elephant trunk with Frozenix prosthesis","volume":"9","author":"Okita","year":"2020","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/1089253216659701","article-title":"Hybrid Techniques for Aortic Arch Aneurysm Repair","volume":"20","author":"Sultan","year":"2016","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"251","DOI":"10.21037\/acs.2016.05.03","article-title":"Frozen elephant trunk for DeBakey type 1 dissection: The Cleveland Clinic technique","volume":"5","author":"Roselli","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"i35","DOI":"10.1093\/ejcts\/ezw338","article-title":"Role of the frozen elephant trunk procedure for chronic aortic dissection","volume":"51","author":"Roselli","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1097\/01.RVI.0000159205.00299.97","article-title":"Hybrid endograft for one-step treatment of multisegment disease of the thoracic aorta","volume":"16","author":"Chavan","year":"2005","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1016\/j.jtcvs.2015.01.044","article-title":"The elephant trunk is freezing: The Hannover experience","volume":"149","author":"Shrestha","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_20","first-page":"653","article-title":"Angioscopy as a supplement to frozen elephant trunk treatment","volume":"2","author":"Tsagakis","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e016695","DOI":"10.1161\/JAHA.120.016695","article-title":"Anatomic Suitability for Branched Thoracic Endovascular Repair in Patients with Aortic Arch Pathological Features","volume":"9","author":"Smorenburg","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0003-4975(00)01535-6","article-title":"Total Arch Replacement Using Aortic Arch Branched Grafts With the Aid of Antegrade Selective Cerebral Perfusion","volume":"70","author":"Kazui","year":"2000","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1253\/circj.CJ-18-0969","article-title":"Outcomes of Early-Onset Acute Type A Aortic Dissection\u2014Influence of Etiologic Factors","volume":"83","author":"Kimura","year":"2019","journal-title":"Circ. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1016\/j.jtcvs.2003.11.038","article-title":"Upper and lower spinal cord blood supply: The continuity of the anterior spinal artery and the relevance of the lumbar arteries","volume":"127","author":"Biglioli","year":"2004","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"244","DOI":"10.21037\/acs.2020.02.01","article-title":"Normothermic frozen elephant trunk surgery without circulatory arrest: How we do it in Ancona","volume":"9","author":"Cefarelli","year":"2020","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_26","first-page":"107","article-title":"Open Aortic Arch Repair: State-of-the-Art and Future Perspectives","volume":"25","author":"Ouzounian","year":"2013","journal-title":"Semin. Thoracic. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/4\/1120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:23:35Z","timestamp":1760135015000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/4\/1120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,20]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11041120"],"URL":"https:\/\/doi.org\/10.3390\/jcm11041120","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,20]]}}}