Distal Seal to Prevent Type 1b Endoleaks in Frozen Elephant Trunk Operation With Hybrid Stent Grafts in Acute Aortic Dissections

We congratulate Zhu and Bu on their novel hybrid technique (proximal continuous suture, distal balloon dilatation) for ensuring a distal seal in hybrid stent grafts.1,2 Their excellent, limited experience shows promise and advantages in their practice. Whether this is done blindly during circulatory arrest after stent graft deployment or later after cessation of bypass was unclear. Type, sizing of balloons, inflation pressures, and whether done in a hybrid operating room were not mentioned, neither were the criteria for ballooning.