Aortic remodelling in aortic dissection after frozen elephant trunk†

Area of Science:

• Vascular Surgery
• Cardiovascular Imaging
• Aortic Disease Management

Background:

• Frozen elephant trunk (FET) is utilized for continuous downstream aorta treatment in acute aortic dissection (AAD) and chronic aortic dissection (CAD).
• Understanding aortic lumen remodeling post-FET implantation is crucial for long-term outcomes.
• This study investigates volumetric changes in the aorta following FET repair.

Purpose of the Study:

• To evaluate aortic lumen remodeling after FET repair in patients with AAD and CAD.
• To quantify changes in aortic lumen (AL) and true lumen (TL) volumes at different aortic segments.
• To identify predictors of negative remodeling and potential need for reintervention.

Main Methods:

• Retrospective analysis of 70 patients (48 AAD, 22 CAD) with pre-, post-operative, and follow-up imaging (≥1 year).
• Quantification of AL and TL volume changes in three aortic segments: stent graft segment (A), downstream to celiac trunk (B), and distal to bifurcation (C).
• Classification of remodeling as positive, stable, or negative based on >10% volume changes.

Main Results:

• In AAD, positive or stable remodeling was observed in 90% (A), 65% (B), and 58% (C) at 1 year, persisting in most at long-term follow-up.
• In CAD, positive or stable remodeling was seen in 100% (A), 86% (B), and 77% (C) at 1 year, with decreased rates distally at long-term follow-up.
• Negative remodeling in ≥2 segments occurred in 19% of AAD and 43% of CAD patients, with 5 CAD patients requiring reintervention.

Conclusions:

• FET effectively facilitates positive aortic remodeling in both AAD and CAD, extending to the distal aorta.
• A significant proportion of CAD patients (40%) and a smaller percentage of AAD patients (20%) exhibit distal negative remodeling.
• Negative remodeling in multiple segments on follow-up imaging identifies patients at risk for secondary reintervention.