title: Surgical treatment of complex aneurysms and thoracic aortic dissections with the Frozen Elephant Trunk technique.
abstract: OBJECTIVE
  Report initial experience with the Frozen Elephant Trunk technique.
  
  
  METHODS
  From July 2009 to October 2013, Frozen Elephant Trunk technique was performed in 21 patients (66% male, mean age 56 ± 11 years). They had type A aortic dissection (acute 9.6%, chronic 57.3%), type B (14.3%, all chronic) and complex aneurysms (19%). It was 9.5% of reoperations and 38% of associated procedures (25.3% miocardial revascularization, 25.3% replacement of aortic valve and 49.4% aortic valved graft). Aortic remodeling was evaluated comparing preoperative and most recent computed tomography scans. One hundred per cent of complete follow-up, mean time of 28 months.
  
  
  RESULTS
  In-hospital mortality of 14.2%, being 50% in acute type A aortic dissection, 8.3% in chronic type A aortic dissection, 33.3% in chronic type B aortic dissection and 0% in complex aneurysms. Mean times of cardiopulmonary bypass (152 ± 24 min), myocardial ischemia (115 ± 31 min) and selective cerebral perfusion (60 ± 15 min). Main complications were bleeding (14.2%), spinal cord injury (9.5%), stroke (4.7%), prolonged mechanical ventilation (4.7%) and acute renal failure (4.7%). The need for second-stage operation was 19%. False-lumen thrombosis was obtained in 80%.
  
  
  CONCLUSIONS
  Frozen Elephant Trunk is a feasible technique and should be considered. The severity of the underlying disease justifies high mortality rates. The learning curve is a reality. This approach allows treatment of more than two segments at once. Nonetheless, if a second stage is made necessary, it is facilitated.
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
authors.forename: Ricardo Ribeiro
authors.initials: RR
authors.lastname: Dias
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Duncan
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
authors.forename: Diego Sarty
authors.initials: DS
authors.lastname: Vianna
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
authors.forename: Leandro Batisti
authors.initials: LB
authors.lastname: de Faria
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
authors.forename: Fábio
authors.initials: F
authors.lastname: Fernandes
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
authors.forename: Félix José Álvares
authors.initials: FJ
authors.lastname: Ramirez
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
authors.forename: Fábio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome