{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T13:11:15Z","timestamp":1793711475255,"version":"4.6.1"},"reference-count":48,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Acute type A aortic dissection (ATAAD) is an indisputable emergency with very poor outcomes without surgical treatment. Although the aortic arch is often involved in the aortic dissection, its optimal management during surgical therapy remains uncertain. A conservative tear-oriented approach has traditionally been adopted, limiting the procedure to the ascending aorta (or hemiarch) replacement. However, dilation of the residual dissected aorta and subsequent rupture may occur, requiring further intervention in the future. In the last two decades, the frozen elephant trunk (FET) technique has become a valid and attractive option to treat aortic disease when the arch and the thoracic aorta are involved, both in elective and in emergency settings. Here, we report a review of the contemporary literature regarding the short- and long-term outcomes of the FET technique in ATAAD repair.<\/jats:p>","DOI":"10.3390\/medicina57090894","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T22:49:51Z","timestamp":1630363791000},"page":"894","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Frozen Elephant Trunk Technique in Acute Type A Aortic Dissection: Is It for All?"],"prefix":"10.3390","volume":"57","author":[{"given":"Pierpaolo","family":"Chivasso","sequence":"first","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Generoso","family":"Mastrogiovanni","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Miele","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito Domenico","family":"Bruno","sequence":"additional","affiliation":[{"name":"Translational Health Science Department, Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Rosciano","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Pio","family":"Montella","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donato","family":"Triggiani","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Colombino","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Cafarelli","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Leone","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Masiello","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Severino","family":"Iesu","sequence":"additional","affiliation":[{"name":"Department of Emergency Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, 84126 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/S0003-4975(01)03449-X","article-title":"Acute type A dissection: Conservative methods provide consistently low mortality","volume":"73","author":"Westaby","year":"2002","journal-title":"Ann. Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.cjca.2015.07.736","article-title":"State-of-the-Art Surgical Management of Acute Type A Aortic Dissection","volume":"32","author":"Ouzounian","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"346","DOI":"10.21037\/acs.2016.05.10","article-title":"IRAD experience on surgical type A acute dissection patients: Results and predictors of mortality","volume":"5","author":"Berretta","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.jacc.2015.05.029","article-title":"Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection","volume":"66","author":"Pape","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2628","DOI":"10.1016\/j.jacc.2015.04.030","article-title":"The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection","volume":"65","author":"Czerny","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1016\/j.jtcvs.2014.07.098","article-title":"Frozen elephant trunk surgery in acute aortic dissection","volume":"149","author":"Pantaleo","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1093\/ejcts\/ezu185","article-title":"Total aortic arch replacement with frozen elephant trunk in acute type A aortic dissections: Are we pushing the limits too far?","volume":"47","author":"Shrestha","year":"2015","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1016\/j.athoracsur.2007.06.045","article-title":"Is Emergency Total Arch Replacement with a Modified Elephant Trunk Technique Justified for Acute Type A Aortic Dissection?","volume":"84","author":"Watanuki","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1016\/j.athoracsur.2015.06.007","article-title":"Is Total Arch Replacement Associated with Worse Outcomes During Repair of Acute Type A Aortic Dissection?","volume":"100","author":"Rice","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S197","DOI":"10.1016\/j.jtcvs.2012.11.068","article-title":"Simplified frozen elephant trunk repair for acute DeBakey type I dissection","volume":"145","author":"Roselli","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.athoracsur.2015.02.041","article-title":"Total arch replacement versus more conservative management in type a acute aortic dissection","volume":"100","author":"Berretta","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.jtcvs.2020.07.061","article-title":"Commentary: Aortic surgery in patients with Loeys\u2013Dietz syndrome: When, why, and how?","volume":"160","author":"Iesu","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"i4","DOI":"10.1093\/ejcts\/ezw337","article-title":"Patient management in aortic arch surgery\u2020","volume":"51","author":"Peterss","year":"2017","journal-title":"Eur. J. Cardio-Thoracic Surg."},{"key":"ref_14","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_15","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1016\/j.athoracsur.2015.12.032","article-title":"Open Seldinger-Guided Femoral Artery Cannulation Technique for Thoracic Aortic Surgery","volume":"101","author":"Tsiouris","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S282","DOI":"10.1161\/CIRCULATIONAHA.108.844480","article-title":"Comparison of Ascending Aorta Versus Femoral Artery Cannulation for Acute Aortic Dissection Type A","volume":"120","author":"Kamiya","year":"2009","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2936","DOI":"10.1016\/j.jtcvs.2014.05.082","article-title":"The impact of arterial cannulation strategy on operative outcomes in aortic surgery: Evidence from a comprehensive meta-analysis of comparative studies on 4476 patients","volume":"148","author":"Benedetto","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/jocs.15208","article-title":"A modified frozen elephant trunk hybrid device to facilitate supra-aortic trunk anastomosis","volume":"36","author":"Masiello","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S1844","DOI":"10.1016\/S0003-4975(02)04155-3","article-title":"Impact of an aggressive surgical approach on surgical outcome in type a aortic dissection","volume":"74","author":"Kazui","year":"2002","journal-title":"Ann. Thorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1053\/j.jvca.2020.11.035","article-title":"Brain Protection in Aortic Arch Surgery: An Evolving Field","volume":"35","author":"Qu","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.athoracsur.2006.02.034","article-title":"Incomplete Circle of Willis and Right Axillary Artery Perfusion","volume":"82","author":"Merkkola","year":"2006","journal-title":"Ann. Thorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"230","DOI":"10.21037\/acs-2019-fet-10","article-title":"The frozen elephant trunk technique in acute and chronic aortic dissection: Intraoperative setting and patient selection are key to success","volume":"9","author":"Berger","year":"2020","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.1016\/j.jtcvs.2014.08.008","article-title":"Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection","volume":"149","author":"Kimura","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1016\/j.athoracsur.2007.07.017","article-title":"Fate of the Residual Distal and Proximal Aorta After Acute Type A Dissection Repair Using a Contemporary Surgical Reconstruction Algorithm","volume":"84","author":"Geirsson","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.athoracsur.2009.06.055","article-title":"Long-Term Results After Repair of Type A Acute Aortic Dissection According to False Lumen Patency","volume":"88","author":"Fattouch","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3133","DOI":"10.1161\/CIRCULATIONAHA.111.090266","article-title":"Long-Term Outcome of Aortic Dissection with Patent False Lumen","volume":"125","author":"Evangelista","year":"2012","journal-title":"Circulation"},{"key":"ref_27","first-page":"1261","article-title":"Facilitated aortic arch repair with the frozen elephant trunk technique","volume":"40","author":"Petridis","year":"2011","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1097\/SLA.0000000000003122","article-title":"A New Aortic Arch Inclusion Technique with Frozen Elephant Trunk for Type A Aortic Dissection","volume":"271","author":"Liu","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1093\/icvts\/ivaa199","article-title":"The frozen elephant trunk technique for acute retrograde type A aortic dissection: Preliminary results","volume":"31","author":"Kaneyuki","year":"2020","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1093\/ejcts\/ezz104","article-title":"Comparative study of the frozen elephant trunk and classical elephant trunk techniques to supplement total arch replacement for acute type A aortic dissection","volume":"56","author":"Inoue","year":"2019","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1093\/icvts\/ivz154","article-title":"Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection","volume":"29","author":"Furutachi","year":"2019","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1093\/ejcts\/ezu173","article-title":"The frozen elephant trunk technique for acute type A aortic dissection: Results from 15 years of experience","volume":"47","author":"Katayama","year":"2015","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.jtcvs.2013.02.013","article-title":"Treatment strategies for left subclavian artery during total arch replacement combined with stented elephant trunk implantation","volume":"147","author":"Xiao","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13019-014-0140-6","article-title":"A modified total arch replacement combined with a stented elephant trunk implantation for acute type A dissection under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion","volume":"9","author":"Yang","year":"2014","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1016\/j.jtcvs.2013.10.058","article-title":"Early and midterm outcomes of hemiarch replacement combined with stented elephant trunk in the management of acute DeBakey type I aortic dissection: Comparison with total arch replacement","volume":"148","author":"Shi","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_36","first-page":"621","article-title":"Sun\u2019s procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: Analysis of early outcome in 398 patients with acute type A aortic dissection","volume":"2","author":"Ma","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1016\/j.jtcvs.2012.03.059","article-title":"Thoracic stent graft sizing for frozen elephant trunk repair in acute type A dissection","volume":"145","author":"Hoffman","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_38","first-page":"1066","article-title":"Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection","volume":"40","author":"Uchida","year":"2011","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1510\/icvts.2010.238212","article-title":"The stented elephant trunk procedure combined total arch replacement for Debakey I aortic dissection: Operative result and follow-up","volume":"11","author":"Chen","year":"2010","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S116","DOI":"10.1016\/j.jtcvs.2010.07.066","article-title":"Multicenter early experience with extended aortic repair in acute aortic dissection: Is simultaneous descending stent grafting justified?","volume":"140","author":"Tsagakis","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.athoracsur.2009.04.046","article-title":"Antegrade Thoracic Stent Grafting During Repair of Acute DeBakey I Dissection Prevents Development of Thoracoabdominal Aortic Aneurysms","volume":"88","author":"Pochettino","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.athoracsur.2008.03.037","article-title":"Combining Classic Surgery with Descending Stent Grafting for Acute DeBakey Type I Dissection","volume":"86","author":"Jakob","year":"2008","journal-title":"Ann. Thorac. Surg."},{"key":"ref_43","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. Cardio-Thorac. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1796","DOI":"10.1016\/j.jacc.2013.10.085","article-title":"Outcomes of Acute Type A Dissection Repair Before and After Implementation of a Multidisciplinary Thoracic Aortic Surgery Program","volume":"63","author":"Andersen","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/2047487318764963","article-title":"Aortic centres should represent the standard of care for acute aortic syndrome","volume":"25","author":"Mariscalco","year":"2018","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1016\/j.athoracsur.2013.02.039","article-title":"National Outcomes in Acute Aortic Dissection: Influence of Surgeon and Institutional Volume on Operative Mortality","volume":"95","author":"Chikwe","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_47","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":"2016","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5090\/kjtcs.2017.50.1.1","article-title":"The Frozen Elephant Trunk Technique: European Association for Cardio-Thoracic Surgery Position and Bologna Experience","volume":"50","author":"Pantaleo","year":"2017","journal-title":"Korean J. Thorac. Cardiovasc. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/894\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:54:16Z","timestamp":1760165656000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,28]]},"references-count":48,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["medicina57090894"],"URL":"https:\/\/doi.org\/10.3390\/medicina57090894","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,28]]}}}