Key result
Femoral ECMO retrograde perfusion can induce stenosis in the non-stent distal Frozenix graft.
Why the study?
Frozenix Partial ET was designed to lower dSINE incidence, but literature on its efficacy and complications is limited due to its novelty.
Case Report (n=1)
No
The non-stent distal portion of the Frozenix Partial ET device can develop stenosis during retrograde perfusion from femoral ECMO, highlighting the need for careful cannulation site selection.
Answers are grounded in this paper and cite their sources.
Unanticipated distal stenosis occurred with retrograde perfusion using Frozenix Partial ET; leaves open whether cannulation strategy requires modification in ECMO or redo surgery.
BACKGROUND: Total arch replacement with frozen elephant trunk (FET) has been reported to be associated with favorable aortic remodeling when used for aortic dissection. However, several complications associated with FET have been reported, including distal stent graft-induced new entry (dSINE), which potentially results in aortic rupture and late mortality. Frozenix Partial ET (Japan Lifeline Inc., Tokyo, Japan) is a unique FET device that has a non-stent zone at the distal 2 cm end to decrease the radial force to lower the incidence of dSINE. Owing to its novelty, there are few preceding literatures regarding its efficacy and complications. In this report, we present a case of an unanticipated complication arising from the use of Frozenix Partial ET subsequent to the initiation of extracorporeal membrane oxygenation (ECMO). CASE PRESENTATION: A 54-year-old male diagnosed with Stanford type A acute aortic dissection underwent emergency total aortic arch replacement, frozen elephant trunk with Frozenix partial ET (Japan Lifeline Inc., Tokyo, Japan), the Bentall procedure, and coronary artery bypass grafting. The patient developed cardiogenic shock, requiring extracorporeal membrane oxygenation with left common femoral artery and vein cannulation on postoperative day 1. Despite adequate ECMO flow, high doses of catecholamines were required to maintain blood pressure measured at the right radial artery. Transesophageal echocardiography revealed stenosis of the distal part of the FET presumably due to retrograde perfusion from the femoral artery. The addition of left axillary artery cannulation improved systemic circulation, reducing the dose of catecholamine. CONCLUSION: Although designed to reduce the risk of dSINE, Frozenix Partial ET may induce unforeseen complications. Particularly, its non-stent distal part can become stenotic under conditions of retrograde perfusion. Surgeons should carefully choose where to cannulate in patients with this device requiring redo surgery or ECMO support.
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Niki et al. (2025) conducted a case report in Stanford type A acute aortic dissection (n=1). Frozenix Partial ET and retrograde ECMO perfusion was evaluated on Stenosis of the distal edge of the frozen elephant trunk. The non-stent distal part of the Frozenix Partial ET can become stenotic under conditions of retrograde perfusion, such as during femoral ECMO support.
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