Berretta Paolo, D'Alessio Simone, Malvindi Pietro G, D'Alfonso Alessandro, Cefarelli Mariano, Galeazzi Michele, Bifulco Olimpia, Giusti Martina, Vento Vincenzo, Spagnolo Francesca, Gatta Emanuele, Di Eusanio Marco
Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy.
Vascular Surgery Unit, Lancisi Cardiovascular Center, Ancona, Italy.
Ann Cardiothorac Surg. 2025 Jul 31;14(4):291-302. doi: 10.21037/acs-2025-evet-0042. Epub 2025 Jul 28.
Aortic arch surgery has evolved significantly with novel techniques aimed at reducing morbidity and mortality. Traditional approaches rely on hypothermic circulatory arrest (HCA), which remains associated with neurological and systemic complications. This study presents our initial experience with a normothermic frozen elephant trunk (FET) technique that eliminates circulatory arrest while maintaining continuous cerebral and systemic perfusion.
A retrospective analysis was conducted on consecutive patients who underwent FET without HCA at Polytechnic University of Marche from September 2019 to January 2025. The surgical strategy included femoral and innominate artery cannulation for extracorporeal circulation, antegrade selective cerebral perfusion (ASCP), and retrograde stent graft deployment with balloon occlusion. Perioperative outcomes, complications, and mid-term follow-up data were evaluated.
Twenty-three patients (median age, 73 years) underwent FET without HCA. Indications included degenerative aneurysm (n=14), type I endoleak (n=4), acute aortic dissection (n=2), chronic penetrating ulcer (n=2), and Kommerell's diverticulum (n=1). Technical success was 100%. Two in-hospital deaths occurred due to septic shock and stroke. No cases of permanent spinal cord injury were reported. The median intensive care unit and hospital stays were 4 and 10 days, respectively. The median peak intraoperative lactate level was 1.8 mmol/L (range, 1-4.8 mmol/L). At a median follow-up of 27 months, three patients required distal aortic reintervention due to type Ib (n=2) and type II (n=1) endoleaks.
Normothermic FET without circulatory arrest is a feasible and potentially advantageous alternative to traditional techniques, reducing ischemia-reperfusion injury while maintaining cerebral and systemic perfusion. Early outcomes suggest promising results in selected patients, though further studies with larger cohorts are necessary to validate long-term safety and efficacy.
Frozen elephant trunk (FET); normothermic frozen elephant trunk (normothermic FET); cardiac arrest; FET without circulatory arrest; aortic arch surgery.
主动脉弓手术已随着旨在降低发病率和死亡率的新技术而显著发展。传统方法依赖于低温循环停止（HCA），但仍与神经和全身并发症相关。本研究展示了我们使用常温冷冻象鼻（FET）技术的初步经验，该技术可消除循环停止，同时维持持续的脑和全身灌注。
对2019年9月至2025年1月在马尔凯理工大学接受无HCA的FET手术的连续患者进行回顾性分析。手术策略包括股动脉和无名动脉插管进行体外循环、顺行选择性脑灌注（ASCP）以及带球囊封堵的逆行支架移植物置入。评估围手术期结果、并发症和中期随访数据。
23例患者（中位年龄73岁）接受了无HCA的FET手术。适应证包括退行性动脉瘤（n = 14）、I型内漏（n = 4）、急性主动脉夹层（n = 2）、慢性穿透性溃疡（n = 2）和Kommerell憩室（n = 1）。技术成功率为100%。2例患者在住院期间因感染性休克和中风死亡。未报告永久性脊髓损伤病例。重症监护病房和住院时间的中位数分别为4天和10天。术中乳酸峰值的中位数为1.8 mmol/L（范围1 - 4.8 mmol/L）。在中位随访27个月时，3例患者因Ib型（n = 2）和II型（n = 1）内漏需要进行远端主动脉再次干预。
无循环停止的常温FET是传统技术的一种可行且可能具有优势的替代方法，可减少缺血再灌注损伤，同时维持脑和全身灌注。早期结果表明在选定患者中前景良好，不过需要进一步开展更大样本队列研究以验证长期安全性和有效性。
冷冻象鼻（FET）；常温冷冻象鼻（常温FET）；心脏骤停；无循环停止的FET；主动脉弓手术
