Contemporary Single-Center Experience of Complete Aortic Arch Replacement Employing the Frozen Elephant Trunk Technique in Patients with Extensive Aortic Disease

<b>Objective:</b> This study aimed to examine contemporary results of the frozen elephant trunk (FET) procedure in an all-comers patient cohort. <b>Methods:</b> Between January 2017 and May 2024, a total of 132 consecutive patients with either aortic aneurysm (<i>n</i> = 32), acute aortic dissection (<i>n</i> = 32), or chronic aortic dissection (<i>n</i> = 68) underwent total aortic arch replacement employing the FET technique. In-hospital data were collected prospectively and included preoperative characteristics, intraoperative data, and follow-up results. <b>Results:</b> The median cardiopulmonary bypass time, cardiac ischemia time, and selective antegrade cerebral perfusion time were 180 (161-205), 89 (70-113), and 45 (38-54) min, respectively. Total 30-day mortality rate was 7.6% (<i>n</i> = 10). The rate of major postoperative neurological complications was 6.8% (<i>n</i> = 9) for perioperative stroke and 2.3% (<i>n</i> = 3) for permanent spinal cord injury. Five patients (3.8%) required hemofiltration at the time of discharge due to postoperative kidney injury. Rates of subsequent endovascular and open aortic repair following primary FET were 40.9% (<i>n</i> = 54) and 3.8% (<i>n</i> = 5), respectively. The median time to reintervention was 86 (30-439) days. The median follow-up time was 25 (8-52) months, and overall survival rates at 1, 2, and 3 years were 89%, 89%, and 87%, respectively. <b>Conclusions:</b> Our data are consistent with current reports, indicating that the FET technique is a valuable adjunct in treating extensive aortic arch pathologies. The procedure provides an increasingly safe and effective option for complete aortic arch replacement, even in patients requiring a redo procedure.