Custom-Made E-Vita Graft for Frozen Elephant Trunk With Arch-First Technique.

A novel custom-made E-Vita Open prosthesis (JOTEC GmbH, Hechingen, Germany) has been designed with 2 additional side branches. The first one, the reperfusion branch, allows distal aortic perfusion after the collar anastomosis of a frozen elephant trunk repair has been performed. The second one, the debranching branch, permits reimplantation of any configuration of supraaortic debranching to the dacron graft. This modified graft provides two main advantages: first, combined with prior carotid-subclavian bypass and bilateral axillary perfusion, it allows continuous bihemispheric antegrade perfusion and arch-first technique under mild hypothermia (32°C); second, it grants distal aortic reperfusion after distal anastomosis completion performed under moderate hypothermia (28°C).