Frozen Elephant Trunk procedure with E-Vita Open NEO: Initial experience at Acibadem City Clinic Hospital Vitosha

Background: Extensive aortic arch and proximal descending aortic pathologies traditionally require multi-stage repair. The Frozen Elephant Trunk (FET) technique allows one-stage ascending aorta and total arch replacement with antegrade stent-graft deployment, enabling complete repair and a platform for future endovascular interventions. The E-vita Open NEO hybrid prosthesis incorporates design improvements that facilitate deployment, shorten ischemic times, and reduce the risk of neurological complications. Objective: The main objective of this case series is to present the initial experience with FET using the E-vita Open NEO graft at Acibadem City Clinic Hospital Vitosha, illustrating feasibility, safety, and early outcomes. Methods: Four elective patients with complex thoracic aortic disease (degenerative aneurysms and chronic post-dissection aneurysms) underwent ascending aorta and total arch replacement with FET using the E-vita Open NEO prosthesis. Procedures were performed via median sternotomy with cardiopulmonary bypass, hypothermic circulatory arrest, and selective antegrade cerebral perfusion. Trifurcated or branched grafts were selected according to arch anatomy. Results: All patients survived with no in-hospital mortality, stroke, or spinal cord injury. Circulatory arrest times ranged 45–60 minutes. Postoperative imaging confi rmed correct stent deployment, patent arch branches, and favorable aortic remodeling, including false lumen thrombosis in dissection cases. The device facilitated precise distal deployment and simplifi ed arch reconstruction without graft-related complications. Conclusions: FET with the E-vita Open NEO is feasible and safe in a newly established aortic program. One-stage repair achieved complete anatomical correction, avoided staged procedures, and promoted early aortic remodeling. Early outcomes are consistent with international experience, supporting FET as a standard approach for extensive thoracic aortic disease.