Long-term outcomes of the frozen elephant trunk procedure: a systematic review

David H. Tian*, Hakeem Ha, Yashutosh Joshi, Tristan D. Yan

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    34 Citations (Scopus)
    24 Downloads (Pure)


    Background: The frozen elephant trunk (FET) procedure remains an increasingly popular approach to address complex multi-segmental aortic pathologies, owing to their ability to promote false lumen thrombosis and reduce the need for second-stage operations. While the short-term outcomes of such procedures have been shown to be acceptable, much less is known regarding long-term outcomes. This systematic review evaluates long-term outcomes of the FET procedure.

    Methods: Studies with at least 12 months follow-up data on FETs were identified in four electronic databases. All studies were reviewed by two independent researchers and relevant data extracted. Long-term outcomes, including overall survival, freedom from reintervention, and freedom from aortic events, were evaluated using patient data recreated from digitized Kaplan-Meier curves.

    Results: Thirty-seven studies with 4,178 patients were identified. The majority of the studies focused solely on acute dissections. Average follow-up was 3.2 years. Overall survival at 1-, 3-, and 5-year was 89.6%, 85.2%, and 82.0%, respectively. Freedom from reintervention at the same timepoints were 93.9%, 89.3%, and 86.8%, respectively. Mortality, permanent neurological deficit and spinal cord injury were 10.2%, 7.7%, and 6.5%, respectively.

    Conclusions: Survival after the FET procedure is favorable, though ongoing close serial monitoring is essential to assess for the need for further reintervention. Larger multi-institutional registries are required to provide more robust evidence to better elucidate the patient cohort that would most benefit from the FET.

    Original languageEnglish
    Pages (from-to)144-151
    Number of pages13
    JournalAnnals of Cardiothoracic Surgery
    Issue number3
    Publication statusPublished - May 2020

    Bibliographical note

    Copyright the Publisher. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


    • Frozen elephant trunk (FET)
    • stent-graft
    • survival
    • freedom from reintervention
    • systematic review


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