Incorrect frozen elephant trunk deployment into the false lumen of a patient with complicated type B acute dissection

Total 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.