AUTHOR=Jubouri Matti , Kayali Fatima , Saha Priyanshu , Ansari Daniyal M. , Rezaei Yousef , Tan Sven Z. C. P. , Mousavizadeh Mostafa , Hosseini Saeid , Mohammed Idhrees , Bashir Mohamad 

TITLE=Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.875078

DOI=10.3389/fcvm.2022.875078

ISSN=2297-055X

ABSTRACT=Background: The introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionised the field of aortivascular surgery by allowing hybrid repair of complex aortic pathologies in a single step through combining an open surgical approach with an endovascular one. FET has been associated with favourable aortic remodelling, however, its is also associated with development of distal stent graft induced new entry (dSINE) tears postoperatively. The rate of aortic remodelling and the incidence of dSINE have been linked together, in addition, there seems to be a relationship between these two variables and FET insetion length as well as graft size. 
Aims: The scope of this review is to highlight the rate of aortic remodelling as well the incidence of dSINE associated with different FET devices available commercially. This review also aimed to investigate the relationship between aortic remodelling, dSINE, FET insertion length and FET graft size.
Methods: We conducted a comprehensive literature search using multiple electronic databases including PubMed, Ovid, Scopus and Embase in order to collate all research evidence on the above mentioned variables.
Results: Thoraflex™ Hybrid Plexus seems to yield optimum aortic remodelling by promoting maximum false thrombosis as well true lumen expansion. Thoraflex Hybrid™ is also associated with the lowest incidence of dSINE post-FET relative to the other FET devices on the market. Aortic remodelling and dSINE do influence each other and are both linked with FET graft length and size.
Conclusion: The FET technique for TAR shows excellent aortic remodelling but is associated with a considerable risk of dSINE development. However, Thoraflex™ Hybrid has demonstrated itself to be the superior FET device on the aortic arch prostheses market. Since aortic remodelling, dSINE, FET insertion length and stent graft size are all interconnect, the choice of FET device length and size must be made with great care for optimum results.