{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:33:09Z","timestamp":1765233189854,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T00:00:00Z","timestamp":1633996800000},"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>The frozen elephant trunk technique (FET) requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft component, which is placed into the proximal descending thoracic aorta (DTA) anterogradely in the proximal descending thoracic aorta. In Europe, two hybrid prostheses are available: the E-evita Open Plus hybrid stent graft system provided by JOTEC (Hechingen, Germany) and the ThoraflexTM Hybrid (Vascutek, Inchinnan Scotland). Recommendations for use are extensive pathologies of the arch in case of acute and chronic aortic dissection, degenerative aneurysm and intramural hematoma. The FET approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally. The remarkable feature of this technique is the possibility to perform more proximally (from zone 3 to zone 0) the distal anastomosis in to the arch. This allows for an easier distal anastomosis, reduced hypothermic circulatory arrest time and decreased risk of paraplegia (&lt;5%). Early results are promising and according to the most recent series the rate of developing post-operative renal insufficiency ranges from 3 to 10%, the risk of stroke from 3% to 8% and mortality from 8\u201315%. The aim of the article will be to provide some knowledge about the use and application of FET procedures in different aortic situations.<\/jats:p>","DOI":"10.3390\/medicina57101090","type":"journal-article","created":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T06:38:41Z","timestamp":1634107121000},"page":"1090","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5825-0112","authenticated-orcid":false,"given":"Carlo","family":"Mariani","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Massarenti Street 8, 40138 Bologna, Italy"},{"name":"Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giacomo","family":"Murana","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Massarenti Street 8, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Leone","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Massarenti Street 8, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Di Marco","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Massarenti Street 8, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Pacini","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Massarenti Street 8, 40138 Bologna, Italy"},{"name":"Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"451","DOI":"10.21037\/acs.2018.04.05","article-title":"Total aortic arch replacement with frozen elephant trunk (Thoraflex)","volume":"7","author":"Pacini","year":"2018","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_2","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\u2020","volume":"43","author":"Shrestha","year":"2013","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jtcvs.2016.02.077","article-title":"Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Single-center results of the first 100 patients","volume":"152","author":"Shrestha","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"178","DOI":"10.21037\/acs-2020-fet-25","article-title":"Results of frozen elephant trunk from the international E-vita Open registry","volume":"9","author":"Tsagakis","year":"2020","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1093\/ejcts\/ezx131","article-title":"Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: Results from an international multicentre registry","volume":"52","author":"Iafrancesco","year":"2017","journal-title":"Eur. J. Cardio-Thoracic Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/ejcts\/ezv045","article-title":"Aortic remodelling in aortic dissection after frozen elephant trunk","volume":"49","author":"Dohle","year":"2016","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_7","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_8","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijcard.2021.04.004","article-title":"Visceral malperfusion after Frozen Elephant Trunk in chronic aortic dissection: Post-operative predictors and outcomes","volume":"335","author":"Mariani","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_9","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","volume":"55","author":"Czerny","year":"2019","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"574","DOI":"10.21037\/acs.2019.08.04","article-title":"Use of the frozen elephant trunk technique for type A intramural hematoma","volume":"8","author":"Murana","year":"2019","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Di Marco, L., Amodio, C., Mariani, C., Costantino, A., and Pacini, D. (2021). Frozen Elephant Trunk in Right Aberrant Subclavian Artery. Ann. Thorac. Surg., in press.","DOI":"10.1016\/j.athoracsur.2021.06.012"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1093\/icvts\/ivab038","article-title":"An aorto-oesophageal fistula treated with total arch repair combined with oesoph-ageal repair","volume":"33","author":"Wang","year":"2021","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S81","DOI":"10.1016\/j.jtcvs.2010.07.039","article-title":"Complex thoracic aortic disease: Single-stage procedure with the frozen elephant trunk technique","volume":"140","author":"Pacini","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","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."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s12055-019-00815-0","article-title":"The frozen elephant trunk surgery: A systematic review analysis","volume":"35","author":"Murana","year":"2019","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"170","DOI":"10.21037\/acs.2020.03.09","article-title":"Open total arch replacement with trifurcated graft and frozen elephant trunk","volume":"9","author":"Beckmann","year":"2020","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"540","DOI":"10.23736\/S0021-9509.18.10597-0","article-title":"The frozen elephant trunk treatment is the operation of choice for all kinds of arch disease","volume":"59","author":"Tsagakis","year":"2018","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_18","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_19","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1093\/ejcts\/ezv310","article-title":"A new device as an open stent graft for extended aortic repair: A multicentre early experience in Japan","volume":"49","author":"Uchida","year":"2015","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/j.athoracsur.2018.04.011","article-title":"Frozen Elephant Trunk for Acute Type B Dissection Involving the Distal Arch in the Hybrid Repair Era","volume":"106","author":"Qi","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_21","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."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1093\/ejcts\/ezz103","article-title":"Open distal anastomosis in the frozen elephant trunk technique: Initial experiences and preliminary results of arch zone 2 versus arch zone 3\u2020","volume":"56","author":"Leone","year":"2019","journal-title":"Eur. J. Cardio-Thorac. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/10\/1090\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:11:55Z","timestamp":1760166715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/10\/1090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,12]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["medicina57101090"],"URL":"https:\/\/doi.org\/10.3390\/medicina57101090","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2021,10,12]]}}}