Delayed Frozen Elephant Trunk without hypothermic circulatory arrest.

Aortic arch disease is one of the most complex and challenging field in cardiac surgery. The recent growing experience in endovascular procedures has allowed the surgeons to approach more complex cases with different strategies. We report herein a complicated Zone 0 Hybrid Arch Repair through a delayed Frozen Elephant Trunk with continuous perfusion of the brain and visceral organ and mild hypothermia avoiding circulatory arrest. This strategy, allowed using endovascular technologies, should be considered useful to reduce the operative risks.