Perioperative and short-term outcomes of total arch reconstruction using a novel frozen elephant trunk stent

Total arch reconstruction (TAR) for thoracic aortic dilatation increasingly incorporates frozen elephant trunk (FET) techniques. However, comparative data on the novel FET stent Fontus^™ versus traditional designs like CRONUS^™ (conventional CRONUS^™ and modified CRONUS^™) remain limited. This study aimed to compare perioperative and short-term outcomes of TAR using the Fontus^™ FET stent with two CRONUS^™ FET-based strategies.

We retrospectively analyzed 267 consecutive patients with thoracic aortic dilatation/aneurysms who underwent surgical procedures at our department between January 2019 and December 2024, of whom 76 were excluded (e.g., concomitant severe comorbidities, without TAR). The remaining 191 patients were grouped by stent type: C-C group (TAR with conventional CRONUS^™ Stent, n = 62), C-F group (TAR with Fontus^™ Stent, n = 54), and M-C group (TAR with modified CRONUS^™ Stent, n = 75). Data on patient characteristics, surgical details, and the occurrence of postoperative complications were collected.

No statistical intergroup differences were found in baseline patient characteristics. All patients recovered well with no intraoperative mortality, and no significant differences in the rate of concomitant procedures and 6-month follow-up outcomes were found in the three groups (p > 0.05). However, the operation time, CPB time, hypothermic circulation time, and SCP time were significantly longer in the C-C group, followed by the M-C group, and finally in the C-F group (p < 0.05). In addition, the C-C group exhibited the highest intraoperative blood loss and intraoperative blood transfusion, followed by the C-F group, with the M-C group showing the lowest levels. Pairwise comparisons showed these differences were statistically significant for groups C-C versus M-C and groups C-C versus C-F. Multivariate binary logistic regression showed that the operative time, CPB time, aortic cross-clamp time, and hypothermic circulatory arrest time were risk factors for postoperative pneumonia.

The Fontus^™ stent significantly reduced operative time and was not associated with increased postoperative complication rates compared with the traditional CRONUS^™ stent. Consequently, the novel Fontus^™ stent may serve as a viable and effective alternative approach for thoracic aortic reconstruction surgery.