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Distal Stent Graft-Induced New Entry After Frozen Elephant Trunk Procedure for Aortic Dissection
Toshifumi Hiraoka1, Tomokuni Furukawa2, Katsuhiko Imai1
1Department of Cardiovascular Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure City, Hiroshima, Japan.
Background:
The purpose of this study was to evaluate the risk factors of distal stent graft-induced new entry (dSINE) after frozen elephant trunk (FET) procedure for aortic dissection (AD) and to consider strategies to prevent this complication.
Methods:
This retrospective review included 52 patients who had undergone aortic arch repair for AD with the FET procedure using J Graft FROZENIX from 2014 to 2020 at a single center. Baseline characteristics, aortic characteristics and mid-term outcomes were compared between patients with and without dSINE. The extent of unfolding of the device and movement of the distal edge of the device were analyzed by multidetector computed tomography. The primary endpoints were survival and freedom from reintervention.
Results:
dSINE was the most prevalent complication after FET procedure, with an incidence of 23%. Eleven of 12 patients with dSINE underwent secondary interventions. dSINE was common in chronic aortic dissection (P = 0.001) and was associated with the residual false lumen area (P < 0.001) and movement distance of the distal edge of the device in the cranial direction (P < 0.001).
Conclusions:
The distal edge of the FET is more likely to move in the cranial direction, and this movement may cause dSINE.
