Acute DeBakey Type I Dissection Repair Using Frozen Elephant Trunk: The Cleveland Clinic Technique

Over the past 3 decades, the standard surgical management for acute DeBakey type I aortic dissection has not significantly changed. Most patients undergo ascending aortic replacement with an interposition graft under hypothermic circulatory arrest with selective root replacement. Nevertheless, with the improvement in overall patient care, acute surgical outcomes continue to improve. The frozen elephant trunk (FET) technique was introduced as a modification to conventional elephant trunk to treat extensive degenerative and chronic dissecting aneurysms involving the aortic arch and the proximal descending aorta. The FET technique converts the conventional elephant trunk procedure—an inherently 2-stage operation—into a 1-stage repair in selected patients and greatly facilitates more distal aortic repair, for others. The surgical strategy is tailored to address individual pathology, based on each patient’s aortic anatomy and disease. FET technique in acute DeBakey type I aortic dissection extends the surgical repair into and beyond the arch with the potential to address some of the limitations of the conventional type I aortic dissection repair, but it has not been widely adopted yet. Only a limited number of institutions have embraced this modality during the acute phase of aortic dissection out of concern that it may be too complicated during an emergency situation. We have developed a simplified technique that has evolved over the past several years and the purpose of this report is to describe it.