Frozen elephant trunk technique with different proximal landing zone for aortic dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic dissection requires complex surgical interventions.
• The frozen elephant trunk (FET) procedure is a key technique for managing extensive aortic dissections.
• Optimizing FET landing zones is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate early and midterm outcomes of the FET procedure based on different proximal landing zones.
• To compare the incidence of complications and false lumen thrombosis between Zone 2 (Z2) and Zone 3 (Z3) FET landing zones.
• To assess the impact of proximal landing zone selection on reintervention rates and overall survival.

Main Methods:

• Retrospective analysis of 44 patients with Type A and B aortic dissections undergoing FET procedure.
• Patients were categorized into Zone 2 (Z2) and Zone 3 (Z3) proximal landing zone groups.
• Outcomes including stroke, delirium, spinal cord ischemia, mortality, false lumen thrombosis, and reintervention rates were monitored.

Main Results:

• No significant differences in early outcomes (stroke, delirium, spinal cord ischemia, 30-day mortality) between Z2 and Z3 groups.
• Comparable 2-year overall survival (61.6% vs 64.2%) and freedom from reintervention (74.1% vs 91.7%) between groups.
• Significantly higher complete false lumen thrombosis rate observed in the Z3 group by 24 months (77% vs 60%).

Conclusions:

• The FET procedure demonstrates comparable early safety and efficacy between Zone 2 and Zone 3 proximal landing zones.
• Proximalization of the FET landing zone (Z2) may be associated with improved false lumen thrombosis in the midterm.
• Further investigation is warranted to fully elucidate the long-term implications of FET landing zone selection on aortic remodeling and reintervention necessity.