• Masahiko Fujii, Hiroyuki Watanabe, Masayoshi Otsu, and Yuta Sugahara.
• Division of Cardiovascular Surgery, Narita Red Cross Hospital, Narita, Japan.
• Eur J Cardiothorac Surg. 2019 Jun 1; 55 (6): 1222-1224.

AbstractTotal arch replacement with frozen elephant trunk (FET) is used for type B acute aortic dissection with insufficient proximal landing zone. Herein, we report incorrect deployment of FET into the false lumen. A 45-year-old man underwent femorofemoral bypass for complicated type B acute aortic dissection. However, chest pain recurred 4 days postoperatively, and an oozing rupture of the dissecting descending aorta was diagnosed. As preoperative computed tomography showed insufficient proximal landing zone and separate chronic aortic dissection of the proximal arch, total arch replacement with FET was performed. Progressive lactic acidosis occurred on postoperative day 2, and computed tomography showed incorrect deployment of the FET into the false lumen, causing true lumen stenosis and intestinal ischaemia. Despite extensive enterectomy and abdominal aorta fenestration for the improvement of true lumen perfusion, the patient died of multiorgan failure on postoperative day 7. Care is required to avoid incorrect deployment of FET when there is a large entry in the proximal descending aorta.© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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