Surgeons use modified ‘frozen elephant trunk’ technique for first heart surgery of its kind
![elephant trunk (FET) technique to treat a middle-aged heart patient, sharing their experience in JACC: Case Reports.[1] This is believed to be the first time surgeons have ever employed this particular approach.](/sites/default/files/styles/top_stories/public/2025-12/screenshot_2025-12-17_at_11.35.54_am.png.webp?itok=CzUoIPKL)
A team of cardiac and vascular surgeons successfully performed a modified version of the frozen elephant trunk (FET) technique to treat a middle-aged heart patient, sharing their experience in JACC: Case Reports.[1] This is believed to be the first time surgeons have ever employed this particular approach.
“Combining open surgery with endovascular repair, the FET technique facilitates complete arch replacement and has become a widely accepted strategy for treating complex aortic arch diseases,” wrote first author Enrico Rinaldi, a researcher with the vascular surgery unit at the San Raffaele Scientific Institute in Italy, and colleagues. “Encouraging results with this method has led to the development of several FET devices for commercial use, available in both off-the-shelf and custom-made configurations. However, despite advancements in device technology, commercially manufactured FET systems are not universally accessible and may be unavailable for urgent or emergency use in specific centers. To address these challenges, alternative techniques inspired by the same principles have been described, showing encouraging outcomes but also presenting some drawbacks.”
Rinaldi et al. detailed their own experience treating a 57-year-old patient who first presented at their outpatient clinic. He had previously undergone a type A aortic dissection in 2018, managed with a Bentall procedure, aortic valve replacement and a hemiarch replacement. He did not attend follow-up appointments as recommended, however. He then underwent a thoracic CT angiogram after a car accident. The imaging results revealed a 5.9-cm aortic arch aneurysm associated with residual dissection, and elective aortic arch replacement using the FET technique was identified as the preferred treatment option.
![A team of cardiac and vascular surgeons successfully performed a modified version of the frozen elephant trunk (FET) technique to treat a middle-aged heart patient, sharing their experience in JACC: Case Reports.[1] This is believed to be the first time surgeons have ever employed this particular approach.](https://cardiovascularbusiness.com/sites/default/files/2025-12/screenshot_2025-12-17_at_11.35.12_am.png)
Back-table modification. (A) The stent graft was separated from the sleeves with a curved mosquito forceps, and the sleeves were excised circumferentially using a scalpel, without damaging line n.1. (B) The distal stent graft segment was manually opened after the sleeves were removed. (C) Detailed view of the completely opened distal stent graft. Images and captions courtesy of JACC: Case Reports and Rinaldi et al.
The patient first underwent a left carotid-to–subclavian artery bypass, and that procedure was seen as a success. The patient was discharged four days following the operation and the aortic arch repair was planned for 15 days later. During the time between planned procedures, however, the patient presented to the emergency room with “acute thoracic pain.” New imaging results confirmed that he had an “impending aortic rupture” and an emergency FET procedure was required.
The standard device used for the FET technique was unavailable, however, due to “logistical constraints.” Due to the urgency of the patient’s situation, the group of surgeons determined that they could not wait on the part to be ordered; they had to act immediately.
The group chose to recreate the FET technique by combining a standard thoracic stent graft with a surgical graft. The modification process took 65 minutes.
The new approach, “C-tag Endograft SanRaffaele Arrangement to Re-create a frozen Elephant trunk” (CESARE),” had the desired result. The patient was discharged one week after treatment. Follow-up imaging three months later confirmed that the procedure had been a success. No patient complications have been reported.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.