Hybrid Repair of Extensive Aortic Arch Aneurysms: Outcomes of Isolated Frozen Elephant Trunk Repair and of Elephant Trunk with Second Stage Thoracic Endovascular Aortic Repair

The combination of aortic arch replacement and distal stent grafting is an effective treatment option (type III hybrid arch repair) for extensive aortic arch aneurysms involving the aortic arch and descending aorta. 1 Bavaria J.E. Vallabhajosyula P. Moeller P. Szeto W. Desai N. Pochettino A. Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes. J Thorac Cardiovasc Surg. 2013; 145: S85-S89 Abstract Full Text Full Text PDF PubMed Scopus (153) Google Scholar It is indicated in patients who are not suitable for extensive open replacement. There are several different methods for distal stent grafting, including isolated frozen elephant trunk (FET) repair, conventional elephant truck (ET) followed by second stage thoracic endovascular aortic repair (TEVAR), and FET followed by TEVAR. 2 Papakonstantinou N.A. Antonopoulos C.N. Baikoussis N.G. Kakisis I. Geroulakos G. Frozen elephant trunk: an alternative surgical weapon against extensive thoracic aorta disease. A three-year meta-analysis. Heart Lung Circ. 2019; 28: 213-222 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar , 3 Yoshitake A. Iida Y. Yamazaki M. Hayashi K. Inaba Y. Shimizu H. Midterm results of 2-stage hybrid arch repair for extensive aortic arch aneurysms. Ann Vasc Surg. 2019; 56: 97-102 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 4 Czerny M. Schmidli J. Adler S. van den Berg J.C. Bertoglio L. Carrel T. et al. Editor’s Choice – 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) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2019; 57: 165-198 Abstract Full Text Full Text PDF PubMed Scopus (174) Google Scholar , 5 Hughes G.C. Vekstein A. Current state of hybrid solutions for aortic arch aneurysms. Ann Cardiothorac Surg. 2021; 10: 731-743 Crossref PubMed Scopus (13) Google Scholar The present study reports the outcomes of 78 consecutive patients with true extensive aortic aneurysms treated by an isolated single stage repair using FET (FET group, n = 32) and by two stage repair including a conventional ET followed by TEVAR (TEVAR group, n = 46). Aortic dissection cases were excluded to avoid bias associated with anatomical complexity. The study was approved by the Institutional Review Board (IRB 2019−0179); the need for individual consent was waived.