Distal Stent Graft-Induced New Entry after Total Arch Replacement with Frozen Elephant Trunk for Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Distal stent graft-induced new entry (dSINE) is an emerging complication after frozen elephant trunk (FET) repair for aortic dissection.
• Understanding the incidence and management of dSINE is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the incidence of dSINE following total arch replacement using FET.
• To analyze the risk factors associated with dSINE development.
• To evaluate the treatment outcomes for dSINE.

Main Methods:

• Retrospective study of 70 patients undergoing FET repair for aortic dissection (August 2014 - March 2020).
• Minimum 6-month postoperative follow-up.
• Analysis of risk factors and treatment strategies for dSINE.

Main Results:

• dSINE occurred in 9 patients (12.9%) at a median of 17.7 months post-surgery.
• No significant difference in dSINE incidence based on dissection classification, phase, or graft oversizing.
• All dSINE patients showed false lumen enlargement; TEVAR successfully treated dSINE in all cases without complications.

Conclusions:

• No independent predictors for dSINE development were identified in this cohort.
• Thoracic endovascular aortic repair (TEVAR) is a safe and effective treatment for dSINE.
• TEVAR for dSINE leads to successful false lumen thrombosis in the thoracic aorta.