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The soft elephant trunk: a new approach in the treatment of aortic dissection
Eduard Charchyan1, Denis Breshenkov1, Yuriy Belov1
1Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia.
Background:
The frozen elephant trunk (FET) technique has revolutionized the surgical management of aortic dissection. However, distal stent-graft-induced new entry (dSINE) and reinterventions remain major challenges. This study presents the long-term results of a dissection-specific (DS) "Soft Elephant Trunk" (SET) (MedEng, Penza, Russia) hybrid prosthesis and its impact on distal remodeling compared to conventional hybrid prosthesis.
Methods:
A retrospective review of hybrid aortic repairs from 2014 to 2024 identified 241 patients with aortic dissection. Patients were categorized into two cohorts: DS SET prosthesis (n=170) and conventional prosthesis (non-DS, n=71). Propensity score matching was performed. Primary endpoints included the incidence of dSINE and aortic reinterventions. Secondary endpoints evaluated perioperative complications and long-term survival. Cox regression analysis identified independent predictors of dSINE.
Results:
Survival rates, freedom from reoperation, and the incidence of dSINE did not differ between the groups. However, cumulative incidence of new events-including distal aortic reoperations and dSINE-was significantly lower in the DS group versus non-DS both before matching (12.9% vs. 29.6%, P<0.001) and after matching (15.5% vs. 29.6%, P=0.04). Long-term endoleak rates (>5 years) were significantly higher in the non-DS group (31.4% vs. 7.1%, P=0.009). According to multivariable Cox regression analysis, the key predictors for dSINE included connective tissue disease [hazard ratio (HR) =3.22, 95% confidence interval (CI): 1.09-9.52, P=0.034], Stanford type B aortic dissection (HR =4.3, 95% CI: 7-14.61, P=0.019), and chronic phase of dissection (HR =7.8, 95% CI: 0.72-84.21, P=0.09). The highest dSINE risk was observed in non-DS patients with chronic dissection (P=0.009), Type B dissection (P=0.012), CTD (P=0.005), and aortic dilation >45 mm (P=0.004).
Conclusions:
In comparison to conventional hybrid grafts, the SET graft exhibits a protective trend against dSINE, particularly in high-risk cases. This strategy may reduce distal complications and the need for secondary interventions, thereby improving long-term patient outcomes.
