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Updated: Dec 18, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Is the frozen elephant trunk technique justified for chronic type A aortic dissection in Marfan syndrome?
Yu Chen1, Wei-Guo Ma1,2, Jian-Rong Li1
1Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China.
Background:
Chronic type A aortic dissection (cTAAD) in Marfan syndrome (MFS) is rare. Surgical experience is limited and the role of frozen elephant trunk (FET) technique remains undefined. We seek to evaluate the safety and efficacy of the total arch replacement (TAR) and FET technique for cTAAD in MFS.
Methods:
The clinical data of sixty-eight patients with MFS undergoing FET and TAR for cTAAD were analyzed.
Results:
Mean age was 35.8±9.7 years and thirty-nine were male (57.4%). Operative mortality was 10.3% (7/68). Stroke occurred in one (1.5%), re-exploration for bleeding in five (7.3%), low cardiac output in four (5.9%), and acute renal failure in two (2.9%). Follow-up was complete in 100% (61/61) at mean 7.3±4.0 years. The false lumen was obliterated in 73.5% across FET and 50.0% in unstented descending aorta (DAo). Distal dilation occurred in twenty patients, six of whom underwent thoracoabdominal aortic replacement, one abdominal aortic replacement and one thoracic endovascular aortic repair (TEVAR). Late death occurred in five. At ten years, 59.8% were free from distal aortic dilation, and the incidences were 23.2% for death, 14.4% for distal reoperation, and 62.4% for reoperation-free survival. Predictors for operative mortality were extra-anatomic bypass [odds ratio (OR), 229.592; P=0.036], preoperative maximal size (DMax) of aortic sinuses (mm) (OR, 1.134; P=0.032) and cardiopulmonary bypass (CPB) time (minute) (OR, 1.061; P=0.041). Risk factors for aortic dilatation included patent false lumen at diaphragmatic hiatus [hazard ratio (HR), 5.374; P=0.008], preoperative DMax (mm) of proximal DAo (HR, 1.068; P=0.001) and renal arteries (HR, 1.102; P=0.005) which also predicted distal reoperation (HR, 1.149; P=0.001). The time from onset to operation (day) (HR, 1.002; P=0.004) and CPB time (minute) (HR, 1.032; P=0.036) predicted late death.
Conclusions:
This study shows that the TAR and FET technique is a safe and durable approach to cTAAD in patients with MFS. The operation should be performed as early as possible to optimize clinical outcomes.
Insights
Total arch replacement with frozen elephant trunk technique is safe for chronic type A aortic dissection in Marfan syndrome. Early intervention optimizes outcomes and reduces risks of aortic dilation and death.
Area of Science:
- Cardiovascular Surgery
- Genetics
- Thoracic Surgery
Background:
- Chronic type A aortic dissection (cTAAD) is rare in Marfan syndrome (MFS).
- Surgical experience and the role of the frozen elephant trunk (FET) technique in MFS-associated cTAAD are limited.
- This study evaluates the safety and efficacy of total arch replacement (TAR) with FET for cTAAD in MFS patients.
Purpose of the Study:
- To assess the safety and efficacy of the total arch replacement (TAR) and frozen elephant trunk (FET) technique for chronic type A aortic dissection (cTAAD) in patients with Marfan syndrome (MFS).
- To identify predictors of operative mortality, aortic dilatation, and late death in this patient cohort.
Main Methods:
- Retrospective analysis of clinical data from 68 patients with MFS undergoing TAR and FET for cTAAD.
- Evaluation of perioperative outcomes, including mortality and complications.
- Long-term follow-up to assess false lumen obliteration, distal aortic dilation, reoperations, and survival.
Main Results:
- Operative mortality was 10.3%. Major complications included stroke (1.5%), re-exploration for bleeding (7.3%), low cardiac output (5.9%), and acute renal failure (2.9%).
- At a mean follow-up of 7.3 years, 73.5% of patients showed false lumen obliteration. Distal aortic dilation occurred in 20 patients, necessitating further interventions.
- Ten-year estimates showed 59.8% freedom from distal aortic dilation, 23.2% incidence of death, and 14.4% for distal reoperation. Predictors for mortality and dilatation were identified.
Conclusions:
- The TAR and FET technique represents a safe and durable surgical approach for managing cTAAD in patients with MFS.
- Early surgical intervention is recommended to improve clinical outcomes and reduce the risk of long-term aortic complications.
