Frozen elephant trunk surgery: where do we go from here?

In a recent review published in this journal by Ius et al. [1], one of the main conclusions was that it is difficult (one of my esteemed surgeons would add ‘worthless ’ [2]) to compare the out-comes after the conventional Elephant Trunk (cET) and the Frozen Elephant Trunk (FET) techniques, mainly due to the differ-ent indications, study intervals and surgical risks that patients may have with these two distinct approaches. Despite this, Leontyev et al. [3] from Leipzig, in their article titled ‘Conventional elephant trunk vs. frozen elephant trunk technique in treatment of patients with thoracic aortic disease: effect on neurological complications’ and published in the present issue of the EJCTS, have summarized their 9-year experience with 171 patients with extensive disease of the thoracic aorta by comparing short- and mid-term out-comes after cET (n = 125) and FET (n = 46) interventions. On the one hand, the authors have confirmed Ius et al.’s assumption