Application of the frozen elephant trunk technique in surgical correction for complex pathology of the ascending aorta, aortic arch, and descending thoracic aorta
DOI:
https://doi.org/10.14739/2310-1210.2025.5.339129Keywords:
aortic aneurysm, aortic arch aneurysm, dissecting aortic aneurysm, frozen elephant trunk procedure, hybrid prosthetic repair of the arch and descending thoracic aortaAbstract
Aim: to summarize the current experience in correcting complex pathology of the ascending aorta, aortic arch, and descending thoracic aorta using the frozen elephant trunk technique.
Materials and methods. This study describes the technique and presents the outcomes of the first 42 operations involving prosthetic replacement of the ascending aorta, aortic arch, supra-aortic vessels, and descending thoracic aorta using the frozen elephant trunk technique. These procedures were performed by the staff of the Department of Surgical Treatment of Aortic Pathology at National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine, during the period from 2020 to 2025. All patients underwent a procedure involving complete replacement of the ascending aorta and arch with supra-aortic vessel reimplantation aorta using the stabilized elephant trunk technique as the first stage of reconstruction for aortic arch pathology.
Results. Hospital mortality rate was 9.5 % (4 patients). Causes of death included acute cerebrovascular accident in 1 case, acute respiratory failure in 1 case, and multiple organ failure in 2 cases. Two patients required delayed re-exploration for tamponade on postoperative days 2–3 due to bleeding. Persistent lower paraplegia was observed in 3 patients; however, in 2 cases, intensive rehabilitation enabled full recovery of motor function. Renal failure requiring dialysis was observed in 5 patients. One patient underwent re-thoracotomy for postoperative bleeding. Prolonged mechanical ventilation (>2 days) was necessary in 6 patients. Following the first-stage procedure, endovascular repair (TEVAR) of the aortic arch and descending thoracic aorta was performed in 3 (7.1 %) patients within a period ranging from 14 days to 3 years after the initial operation to stabilize the descending thoracic aorta and promote true lumen remodeling following dissection. All endovascular procedures were completed without complications.
Conclusions. Radical surgical correction of aortic arch aneurysm or dissection involving supra-aortic vessels or disruption of the anatomical integrity of the arch is feasible using the stabilized elephant trunk technique. Advances in preoperative diagnostics, surgical techniques, optimization of cerebral, spinal, and visceral organ protection, and the availability of hybrid / endovascular approaches have enabled successful treatment of complex pathology involving the ascending aorta, arch, and descending thoracic aorta. The initial outcomes were satisfactory, with a hospital mortality rate of 9.5 % (4 out of 42).
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Copyright (c) 2025 V. I. Kravchenko, I. P. Makohonchuk, I. A. Osadovska, I. M. Kravchenko, K. V. Rudenko
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