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Date Published:
29/04/2025
Online Published:
28/04/2025
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Research Article
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Nguyen, H. D., Nguyen, T. H. L., & Nguyen, H. T. (2025). Application of Minimally Invasive Frozen Elephant Trunk Surgery in Aortic Pathologies : Case Series and literature review. The Vietnam Journal of Cardiovascular and Thoracic Surgery, 50, 134-145. https://doi.org/10.47972/vjcts.v50i.1327
Application of Minimally Invasive Frozen Elephant Trunk Surgery in Aortic Pathologies : Case Series and literature review
Main Article Content
Abstract
Background: The Frozen Elephant Trunk technique has increasingly been utilized in the treatment of complex aortic arch pathologies. This method has demonstrated significant advantages in stabilizing the aorta and reducing vascular and neurological complications. However, due to the need for full thoracotomy and deep hypothermia, this surgical approach carries certain postoperative risks, particularly neurological complications. Minimally invasive cardiac surgical techniques, including their application in aortic pathologies, have been rapidly advancing. Minimally frozen elephant trunk surgery has already been adopted worldwide and has recently started to be applied at select centers in Vietnam. The goal is to minimize the impact on patients, enabling faster postoperative recovery.
Objective: To conduct a preliminary feasibility study on the technical application of an upper hemi-sternotomy approach in frozen elephant trunk surgery and provide a literature review.
Methods: A case series of three clinical cases is described.
Conclusion: The minimally invasive frozen elephant trunk technique using an upper hemi-sternotomy approach was found to be feasible and safe.
Article Details
Keywords
Frozen Elephant Trunk surgery, minimally invasive, aorta
References
1. Crawford ES, Coselli JS, Svensson LG, Safi HJ, Hess KR. Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation. Ann Surg. 1990;211(5):521-37.
2. CRAWFORD ES, CRAWFORD JL, STOWE CL, SAFI HJ. Total Aortic Replacement for Chronic Aortic Dissection Occurring in Patients with and without Marfan's Syndrome. Annals of Surgery. 1984;199(3):358-62.
3. Crawford ES, Svensson LG, Coselli JS, Safi HJ, Hess KR. Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients. J Thorac Cardiovasc Surg. 1989;98(5 Pt 1):659-73; discussion 73-4.
4. Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using "elephant trunk" prosthesis. Thorac Cardiovasc Surg. 1983;31(1):37-40.
5. Kato M, Ohnishi K, Kaneko M, Ueda T, Kishi D, Mizushima T, et al. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation. 1996;94(9 Suppl):II188-93.
6. Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, et al. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. European Journal of Cardio-Thoracic Surgery. 2024;65(2).
7. Risteski P, Radwan M, Boshkoski G, Salem R, Iavazzo A, Walther T, et al. Minimally Invasive Aortic Arch Repair: Technical Considerations and Mid-Term Outcomes. Heart Surg Forum. 2020;23(6):E803-E8.
8. Iba Y, Yamada A, Kurimoto Y, Hatta E, Maruyama R, Miura S. Perioperative Outcomes of Minimally Invasive Aortic Arch Reconstruction with Branched Grafts Through a Partial Upper Sternotomy. Ann Vasc Surg. 2020;65:217-23.
9. Goebel N, Bonte D, Salehi-Gilani S, Nagib R, Ursulescu A, Franke UFW. Minimally Invasive Access Aortic Arch Surgery. Innovations (Phila). 2017;12(5):351-5.
10. Malaisrie SC, Szeto WY, Halas M, Girardi LN, Coselli JS, Sundt TM, et al. 2021 The American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection. The Journal of thoracic and cardiovascular surgery. 2021;162(3):735-58. e2.
11. Heo W, Song SW, Kim TH, Lee JS, Yoo KJ, Cho BK, et al. Differential impact of intimal tear location on aortic dilation and reintervention in acute type I aortic dissection after total arch replacement. J Thorac Cardiovasc Surg. 2019;158(2):327-38 e2.
12. Heo W, Song S-W, Lee S-Y, Kim T-H, Lee J-S, Yoo K-J, et al. Locational impact of luminal communication on aortic diameter changes and reintervention in acute type I aortic dissection. European Journal of Cardio-Thoracic Surgery. 2019;55(6):1037-44.
13. Chakos A, Yan TD. Mini-access branch-first total arch replacement and frozen elephant trunk procedure. Annals of Cardiothoracic Surgery. 2020;9(3):236-43.
14. El-Sayed Ahmad A, Risteski P, Papadopoulos N, Radwan M, Moritz A, Zierer A. Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique. European Journal of Cardio-Thoracic Surgery. 2016;50(1):140-4.
15. Chakos A, Yan TD. Mini-access branch-first total arch replacement and frozen elephant trunk procedure. Ann Cardiothorac Surg. 2020;9(3):236-43.
16. Hong SPD, Tung SN, Huu UN. Trường hợp lâm sàng cải tiến kỹ thuật vòi voi điều trị bệnh động mạch chủ phức tạp tại Bệnh viện Hữu Nghị Việt Đức. Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam. 2021;30:24-30.
17. Tian DH, Wan B, Di Eusanio M, Black D, Yan TD. A systematic review and meta-analysis on the safety and efficacy of the frozen elephant trunk technique in aortic arch surgery. Ann Cardiothorac Surg. 2013;2(5):581-91.
18. Leone A, Beckmann E, Aandreas M, Di Marco L, Pantaleo A, Reggiani LB, et al. Total aortic arch replacement with frozen elephant trunk technique: Results from two European institutes. The Journal of Thoracic and Cardiovascular Surgery. 2020;159(4):1201-11.
19. Preventza O, Liao JL, Olive JK, Simpson K, Critsinelis AC, Price MD, et al. Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients. The Journal of thoracic and cardiovascular surgery. 2020;160(1):20-33. e4.
20. Tabata M, Khalpey Z, Aranki SF, Couper GS, Cohn LH, Shekar PS. Minimal access surgery of ascending and proximal arch of the aorta: a 9-year experience. The Annals of thoracic surgery. 2007;84(1):67-72.
21. Deschka H, Erler S, Machner M, El-Ayoubi L, Alken A, Wimmer-Greinecker G. Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases. European Journal of Cardio-Thoracic Surgery. 2013;43(3):580-4.
22. Risteski P, El-Sayed Ahmad A, Monsefi N, Papadopoulos N, Radacki I, Herrmann E, et al. Minimally invasive aortic arch surgery: Early and late outcomes. Int J Surg. 2017;45:113-7.
2. CRAWFORD ES, CRAWFORD JL, STOWE CL, SAFI HJ. Total Aortic Replacement for Chronic Aortic Dissection Occurring in Patients with and without Marfan's Syndrome. Annals of Surgery. 1984;199(3):358-62.
3. Crawford ES, Svensson LG, Coselli JS, Safi HJ, Hess KR. Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients. J Thorac Cardiovasc Surg. 1989;98(5 Pt 1):659-73; discussion 73-4.
4. Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using "elephant trunk" prosthesis. Thorac Cardiovasc Surg. 1983;31(1):37-40.
5. Kato M, Ohnishi K, Kaneko M, Ueda T, Kishi D, Mizushima T, et al. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation. 1996;94(9 Suppl):II188-93.
6. Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, et al. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. European Journal of Cardio-Thoracic Surgery. 2024;65(2).
7. Risteski P, Radwan M, Boshkoski G, Salem R, Iavazzo A, Walther T, et al. Minimally Invasive Aortic Arch Repair: Technical Considerations and Mid-Term Outcomes. Heart Surg Forum. 2020;23(6):E803-E8.
8. Iba Y, Yamada A, Kurimoto Y, Hatta E, Maruyama R, Miura S. Perioperative Outcomes of Minimally Invasive Aortic Arch Reconstruction with Branched Grafts Through a Partial Upper Sternotomy. Ann Vasc Surg. 2020;65:217-23.
9. Goebel N, Bonte D, Salehi-Gilani S, Nagib R, Ursulescu A, Franke UFW. Minimally Invasive Access Aortic Arch Surgery. Innovations (Phila). 2017;12(5):351-5.
10. Malaisrie SC, Szeto WY, Halas M, Girardi LN, Coselli JS, Sundt TM, et al. 2021 The American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection. The Journal of thoracic and cardiovascular surgery. 2021;162(3):735-58. e2.
11. Heo W, Song SW, Kim TH, Lee JS, Yoo KJ, Cho BK, et al. Differential impact of intimal tear location on aortic dilation and reintervention in acute type I aortic dissection after total arch replacement. J Thorac Cardiovasc Surg. 2019;158(2):327-38 e2.
12. Heo W, Song S-W, Lee S-Y, Kim T-H, Lee J-S, Yoo K-J, et al. Locational impact of luminal communication on aortic diameter changes and reintervention in acute type I aortic dissection. European Journal of Cardio-Thoracic Surgery. 2019;55(6):1037-44.
13. Chakos A, Yan TD. Mini-access branch-first total arch replacement and frozen elephant trunk procedure. Annals of Cardiothoracic Surgery. 2020;9(3):236-43.
14. El-Sayed Ahmad A, Risteski P, Papadopoulos N, Radwan M, Moritz A, Zierer A. Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique. European Journal of Cardio-Thoracic Surgery. 2016;50(1):140-4.
15. Chakos A, Yan TD. Mini-access branch-first total arch replacement and frozen elephant trunk procedure. Ann Cardiothorac Surg. 2020;9(3):236-43.
16. Hong SPD, Tung SN, Huu UN. Trường hợp lâm sàng cải tiến kỹ thuật vòi voi điều trị bệnh động mạch chủ phức tạp tại Bệnh viện Hữu Nghị Việt Đức. Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam. 2021;30:24-30.
17. Tian DH, Wan B, Di Eusanio M, Black D, Yan TD. A systematic review and meta-analysis on the safety and efficacy of the frozen elephant trunk technique in aortic arch surgery. Ann Cardiothorac Surg. 2013;2(5):581-91.
18. Leone A, Beckmann E, Aandreas M, Di Marco L, Pantaleo A, Reggiani LB, et al. Total aortic arch replacement with frozen elephant trunk technique: Results from two European institutes. The Journal of Thoracic and Cardiovascular Surgery. 2020;159(4):1201-11.
19. Preventza O, Liao JL, Olive JK, Simpson K, Critsinelis AC, Price MD, et al. Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients. The Journal of thoracic and cardiovascular surgery. 2020;160(1):20-33. e4.
20. Tabata M, Khalpey Z, Aranki SF, Couper GS, Cohn LH, Shekar PS. Minimal access surgery of ascending and proximal arch of the aorta: a 9-year experience. The Annals of thoracic surgery. 2007;84(1):67-72.
21. Deschka H, Erler S, Machner M, El-Ayoubi L, Alken A, Wimmer-Greinecker G. Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases. European Journal of Cardio-Thoracic Surgery. 2013;43(3):580-4.
22. Risteski P, El-Sayed Ahmad A, Monsefi N, Papadopoulos N, Radacki I, Herrmann E, et al. Minimally invasive aortic arch surgery: Early and late outcomes. Int J Surg. 2017;45:113-7.
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