The frozen elephant trunk: an overview of hybrid prostheses

Thoracic aortic pathologies implicating the aortic arch and the descending thoracic aorta (DTA) are primarily managed with total aortic arch replacement (TAR). This can be performed as a single-procedure hybrid fashion using the frozen elephant trunk technique (FET), which utilizes hybrid prosthesis. Nevertheless, FET presents certain challenges such as distal stent graft-induced new entry (dSINE), negative aortic remodeling, reintervention. The narrative review provides an overview of the four majors FET prosthesis, highlighting their design features, mechanical properties, configurations, and variants, and evaluating their clinical outcomes reported in the literature. The leading prosthesis were compared through their mortality and survival rates, neurological outcomes, dSINE, aortic remodeling and reintervention rates. Four FET devices can be considered the main option on the global market; Thoraflex, E-Vita, Cronus, and Frozenix J Graft. Each hybrid prosthesis (HP) features unique design characteristics, resulting in varying clinical outcomes. Thoraflex and E-Vita are the most widely used and investigated HPs, whilst the use of Cronus and Frozenix is geographically confined to mainly manufacturers' countries. The rates of early mortality, stroke, SCI, dSINE and reintervention rates were found to be comparable among the four devices, yet, Thoraflex seemed to offer most optimal clinical profile.