Rare Aortic Arch Replacement Using Frozen Elephant Trunk Technique

Case Presentation
A patient with a complex and life-threatening aortic arch dissection was recently admitted to Max Super Speciality Hospital, Mohali, requiring an immediate and advanced surgical intervention. The condition involved the aortic arch, the curved portion of the main artery carrying blood from the heart to the brain, arms, and lower body, an area known for its surgical complexity and high risk.
Given the critical nature of the disease and the imminent risk of rupture, timely surgical management was essential to save the patient’s life. 

Diagnosis and Challenges 
Detailed diagnostic imaging confirmed a large aneurysmal dissection of the aortic arch, a condition associated with extremely high mortality if left untreated. Surgical intervention in this region is particularly challenging because it requires protecting blood flow to vital organs, especially the brain. The patient’s condition demanded a highly specialised approach, requiring advanced infrastructure, precise planning, and an experienced multidisciplinary cardiac team.

Management
The patient underwent a Frozen Elephant Trunk (FET) procedure, performed successfully by Dr Shashi Jindal, Cardiothoracic Surgeon at Max Super Speciality Hospital, Mohali.

The Frozen Elephant Trunk technique is a hybrid surgical approach that combines open-heart surgery with endovascular stent grafting in a single stage. The procedure involved deep hypothermic circulatory arrest (DHCA), during which the patient’s body temperature was carefully lowered to allow temporary cessation of blood circulation, including to the brain, ensuring a safe surgical window.

During the surgery, the diseased aortic arch was replaced with a synthetic graft. Subsequently, a specialised four-branched stent graft, known as the “frozen elephant trunk,” was deployed into the descending aorta. This sealed the aneurysm, stabilised the thoracic aorta, and significantly reduced the need for future major surgeries.

Outcome and Follow-Up
The surgery was completed successfully without complications. The patient is recovering well under close postoperative monitoring and is showing encouraging signs of improvement.

This successful outcome marks a significant achievement in the local management of one of the most complex cardiovascular conditions.

Discussion
The Frozen Elephant Trunk procedure is considered one of the most demanding operations in cardiovascular surgery and is performed at only a handful of specialised centres worldwide. Its successful execution requires exceptional surgical expertise, advanced technology, and a highly trained team including anaesthetists, perfusionists, and critical care specialists.

The availability of such advanced aortic surgery at Max Super Speciality Hospital, Mohali, ensures that patients in the Tricity region no longer need to travel long distances for life-saving, high-end cardiac care. This case stands as a milestone in regional healthcare and offers renewed hope to patients with complex aortic diseases.