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The 7 Pillars of the Frozen Elephant Trunk

Total aortic arch replacement is arguably the most complex and invasive operation in cardiovascular surgery. There have been major improvements since the first successful total aortic arch repair in the 1950s, leading to a significant reduction in perioperative morbidity and mortality. Classically, surgical treatment of complex pathologies of the aortic arch involving both the aortic arch and the descending aorta required a two-stage procedure. In 1982, Borst and colleagues introduced the “elephant trunk procedure” to simplify the second-stage operation. In 2001, using stent technology, Borst’s classical elephant trunk technique was modified with a distal stented end to develop the so-called frozen elephant trunk (FET) technique. The introduction of commercially available prefabricated straight and branched FET prostheses has led to off-the-shelf solutions. Our center has published extensively on aortic arch surgery and the FET technique. It is an honor to comment on our 7 pillars of the FET.