Modified total fenestrated frozen elephant trunk technique for acute type A aortic dissection

Total arch replacement (TAR) with a frozen elephant trunk (FET) is a good option for acute type A aortic dissection (ATAAD). The fenestrated FET technique has several advantages: anastomosis-free supra-aortic vessel reconstruction, reduced circulatory arrest time, and an easier distal anastomosis. We adopted a simplified modification using zone 0 anastomosis with a single V-shaped total fenestration in 10 patients. The mean operative, cardiopulmonary bypass, and circulatory arrest times were 236 (145-339), 114 (103-254) and 29 (18-35) minutes, respectively. This technique offers a practical and reproducible alternative when rapid arch reconstruction is required or when deep distal exposure is challenging.