Single centre Asian experience of first 100 cases of frozen elephant trunk procedures: Humble beginning, evolution and lessons learned

BackgroundThe frozen elephant trunk (FET) procedure is developed to treat complex aortic arch diseases. We aimed to share our single centre experience of FET operations over time.MethodsA review of first 100 patients who underwent FET procedures for acute, chronic dissection and thoracic aneurysm from January 2016 to January 2024. The patients were divided into two groups: Group 1 (first 50 cases); Group 2 (subsequent 50 cases) and compared the early and late outcomes.ResultsEarly overall mortality was 9% but reduced with time {12% (6/50) in Group 1 vs. 6% (3/50) in Group 2, <i>p</i> = 0.295} with no deaths among the isolated FET procedures. Morbidity included stroke (4%), spinal cord injury (3%) and temporary renal dialysis (9%). Durations of total operation time, cross clamp, circulatory arrest and cerebral perfusion were shorter in group 2; <i>p</i> < 0.05. Concomitant coronary artery bypass grafting, clamp time >180 min, temperature <20 °C and ventilation >72 h were the significant risk factors for all mortality. The overall 1, 5 and 7-year survival were 93.8, 90.7 and 82.5%, respectively, with freedom from aortic re-intervention reflected at 98.8<b>,</b> 87.8 and 87.8%, accordingly.ConclusionsEarly mortality for FET procedure was significantly reduced to 6% with time and no death among isolated FET. The FET operations became faster with better recovery. Doing more cases, refining surgical techniques and post-operative care are the lessons learned for improvements.