What is the clinical evidence from this study?

Study design: Systematic Review. Population: Aortic arch and descending arch pathologies (n=1675). Intervention: Frozen elephant trunk (FET) technique. Primary outcome: Pooled mortality (30-day or in-hospital).

September 1, 2013151 citationsOpen Access

A systematic review and meta-analysis on the safety and efficacy of the frozen elephant trunk technique in aortic arch surgery.

DTDavid H. Tian BWBenjamin Wan MEMarco Di Eusanio

Key Result

The frozen elephant trunk technique for aortic arch surgery demonstrated acceptable safety with a pooled mortality of 8.3%, stroke rate of 4.9%, and spinal cord injury rate of 5.1%.

Study Design

Type

Systematic Review (n=1,675)

Structured PICO

Does the frozen elephant trunk (FET) technique improve safety and efficacy outcomes in patients with complex pathologies of the aortic arch and proximal descending aorta?

Population

1,675 patients (mean age 56.5 years, 22.8% female) with aortic arch and descending arch pathologies who underwent the frozen elephant trunk procedure across 17 observational studies.

Intervention

Frozen elephant trunk (FET) technique for one-stage repair

Outcome

Perioperative mortality, stroke, and spinal cord injurieshard clinical

The frozen elephant trunk technique for complex aortic arch pathologies demonstrates acceptable perioperative mortality and morbidity risks, supporting its use as a one-stage repair strategy.

Limitations

All included studies were retrospective observational trials
Significant variations in critical surgical parameters across studies
Outcomes could not be stratified according to underlying pathologies
Several specially designed FET prostheses lack FDA approval, introducing geographical confounders
Shortage of long-term data beyond 5 years
Absence of randomized controlled trials comparing FET with other hybrid approaches

Abstract

BACKGROUND: The treatment of complex pathologies of the aortic arch and proximal descending aorta represents a significant challenge for cardiac surgeons. Various surgical techniques and prostheses have been implemented over the past several decades, all with varying degrees of success. The introduction of the frozen elephant trunk (FET) technique facilitates one-stage repair of such pathologies. The present systematic review and meta-analysis aims to assess the safety and efficacy of the FET approach in the current literature. METHODS: Electronic searches were performed using six databases from their inception to July 2013. Relevant studies utilizing the FET technique were identified. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Seventeen studies were identified for inclusion for qualitative and quantitative analyses, all of which were observational reports. Pooled mortality was 8.3%, while stroke and spinal cord injuries were 4.9% and 5.1% respectively. Cardiopulmonary bypass time, myocardial ischemia time, and circulatory arrest time strongly correlated with perioperative mortality in a linear relationship, while moderate correlations between cerebral perfusion time and mortality, and circulatory arrest time and spinal cord injury, were also identified. Five-year survival, reported in five studies, ranged between 63-88%. CONCLUSIONS: Overall, results of the present systematic review and meta-analysis suggest that the FET procedure can be performed with acceptable mortality and morbidity risks.

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