Related Experiment Video
Updated: Jan 11, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Comparison of 3 Surgical Procedures for DeBakey Type I Acute Aortic Dissection: When Is Frozen Elephant Trunk
Hiroshi Sato1,2, Yutaka Iba2, Takuma Mikami3
1Department of Cardiovascular Surgery, Otaru General Hospital, Otaru, Japan.
Objectives:
To compare 3 surgical procedures (ascending aortic replacement [AAR], total arch replacement with conventional elephant trunk [cET], or frozen elephant trunk [FET]) for acute type A aortic dissection (ATAAD). Additionally, the AAR group was stratified by the presence or absence of arch vessel dissection (AVD), and outcomes were evaluated among the 4 groups.
Methods:
Patients who underwent AAR or total arch replacement with cET or FET for DeBakey type I ATAAD between December 2006 to December 2024 at 5 institutions were included. The cumulative incidence of aortic events, defined as aortic enlargement, aortic reintervention, or aorta-related adverse events, was compared between procedures using pairwise comparisons adjusted by inverse probability of treatment weighting.
Results:
Of the total 334 patients, 136 with AAR, 94 with cET, and 104 with FET were enrolled. The 5-year cumulative incidence of aortic events was lower for FET compared with that for cET and AAR (AAR: 57.7% vs cET: 49.1% vs FET: 25.2%). Further stratification of the AAR group revealed worse outcomes for AAR with AVD (hazard ratio, 2.25; 95% confidence interval, 1.28-3.95; P = .005). FET showed superior outcomes compared with all other groups, including AAR without AVD (hazard ratio, 0.25; 95% confidence interval, 0.09-0.67; P = .006).
Conclusions:
FET for ATAAD was associated with a lower incidence of aortic events compared with other procedures. FET may be a beneficial option for ATAAD with AVD, which is associated with a higher incidence of aortic events after AAR.
