Total arch replacement with frozen elephant trunk technique.

Our technique for replacing the aortic arch has evolved in recent years from femoral artery cannulation with retrograde cerebral perfusion and deep hypothermic circulatory arrest, to innominate artery cannulation as our first choice, combined with antegrade cerebral perfusion during systemic circulatory arrest with a nasopharyngeal temperature target of 24 °C, and a trifurcated Y-graft (1-3). We have recently reported in high-risk patients that endovascular technology facilitates the repair of arch aneurysms(4). With the help of endovascular stent grafts, we perform total arch replacement with a frozen elephant trunk (FET) in patients whose aneurysm extends through the upper or the entire descending thoracic aorta. If the aneurysm involves the aortic arch and the upper descending thoracic aorta, the repair is performed as a one-stage procedure with antegrade stent delivery of the endograft. If the aneurysm extends into the entire descending aorta, the repair is performed either in one stage with antegrade or retrograde delivery of the endograft or in two stages with retrograde delivery of the stent graft as the second stage of the repair. Our decision to proceed with one-stage versus two-stage repair is based on specific aortic arch anatomy, the complexity of the proximal repair, and the patient’s comorbidities.