INTRODUCTION
The Frozen Elephant Trunk (FET) procedure has become established as a proven and attractive option to treat aortic disease when the arch and the thoracic aorta are involved to facilitate the conventional two-stage access.1 In acute and chronic aortic dissection, the use of FET can help to expand and stabilize the true lumen and cover eventual supplementary tears but the perceived technical complexity of the operation may be restricting its adoption, especially in the acute setting.2–4 Undoubtedly, the constant development of new branched prostheses, which increases the surgeons’ armamentarium in the treatment of complex aortic arch pathology, plays an important role in reducing the risk of procedural failure.5 At present, there is little evidence weighing the burden of replacing the aortic arch as an additional procedure during elective or emergency proximal aortic repair, thus making comparison with patients undergoing secondary total arch replacement difficult.6 The aim of this study was to evaluate safety and short term outcomes after FET with the ThoraflexTM Hybrid (Terumo Aortic, Inchinnan, Scotland, UK) prosthesis in aortic arch reconstruction both in emergency and elective setting.