120 Current Clinical Outcomes of Frozen Elephant Trunk Prostheses: where is the evidence?

Abstract Introduction The frozen elephant trunk (FET) procedure remains the mainstay treatment for managing complex aortic pathologies due to its ability to minimise the necessity for second-stage surgeries. The technique utilises hybrid prostheses, and although Thoraflex and E-vita have demonstrated favourable outcomes, much less is known about Cronus and Frozenix-J. This systematic review aims to evaluate the efficacy of the main FET prostheses. Methods A comprehensive search of major databases was performed, and relevant studies were identified by two independent reviewers. MetaXL 5.0 was used to calculate pooled rates for early mortality, stroke, Spinal cord injury (SCI), dSINE and reinterventions. Results In total 40 studies were included, encompassing a total of 6168 patients (2605 E-vita, 1566 Thoraflex, 1416 Frozenix-J and 578 Cronus). The 30-day mortality rates were similar for Thoraflex and E-vita 7% (95 CI 5.0-8.0), 5% for Cronus and 2% for Frozenix J. The dSINE rates were highest among the E-vita group (8%) and lowest using Frozenix-J (4%). Similarly, the stroke, SCI and reintervention rates were higher with Thoraflex (8%, 3% and 17% respectively) compared to other prostheses. While the stroke and SCI rates were lowest among Cronus studies (1%). Frozenix-J reported lower stroke and SCI rates (3%). A direct comparison between prostheses could not be performed due to the heterogeneity of studies. Conclusion Each prosthesis features a unique design and features resulting in varying clinical outcomes. Although there are limited studies, the available data suggests favourable outcomes using less widely available prostheses such as Cronus and Frozenix-J prostheses.