Aortic dissection in a Jehovah’s witness: Frozen Elephant Trunk and subsequent 4D flow MRI analysis, a case report

Thoracic aortic surgery in Jehovah's Witness (JW) patients presents a challenge to the surgeon due to the patient's religious-based objection to the use of allogeneic blood products. Recently Frozen elephant trunk (FET) has been proposed as a more definitive treatment for patient presenting with thoracic aortic aneurysm and dissection (TAAAD) especially when the aortic arch is involved. We report a case of treating acute type A aortic dissection with the use of the Frozen Elephant Trunk technique in a 75-year old JW patient. The bloodless strategy included: minimize cardiopulmonary bypass and crossclamp time, minimize hemodilution, the use of intra-operative cell salvage, autologous blood trasfusion and the use of topical hemostatic agents. FET can reduce the risk of bleeding as it protects the distal anastomosis from bleeding by covering it with the stent. To our knowledge this is the fist report of a FET performed in a JW patient with TAAAD. Furthermore, the patient underwent 4D (Four Dimensional) Flow MRI (Magnetic Resonance Imaging) analysis two and a half years after the operation which allowed us to confirm the excellent outcome of the operation and the perfect seal of the prosthesis used.