Evaluation of remodeling of the descending aorta using 3DCT after total arch replacement for acute aortic dissection

The frozen elephant trunk (FET) technique during total arch replacement (TAR) in patients with acute type A aortic dissection (ATAAD) has been shown to promote favorable aortic remodeling. However, few reports have compared the morphological assessments between the conventional elephant trunk (CET) and FET procedures. Here, we investigated whether the FET technique during TAR for the patients with ATAAD could affect aortic remodeling through morphological analysis.

In total, 464 patients diagnosed with ATAAD underwent emergency ascending aorta or TAR between 2010 and 2023. We retrospectively analyzed the clinical data of 28 patients who underwent TAR and postoperative contrast-enhanced computed tomography. We assigned 28 patients to either the CET group (n = 11) or FET group (n = 17). Patient characteristics, postoperative outcomes, and aortic remodeling analysis were collected.

Aortic remodeling analysis showed that the expansion rate of the true lumen (TL) in the descending thoracic aorta was significantly greater in the FET group early and 1 year after surgery. Meanwhile, the shrinkage rate of the false lumen (FL) in the descending thoracic aorta was significantly greater in the FET group early after surgery and tended to be greater in the FET group even 1 year after surgery. Remarkably, the incidence of reintervention of the descending aorta was significantly lower in the FET group.

The FET technique with TAR in patients with ATAAD could improve aortic remodeling through improved TL expansion and preventive FL dilatation in the descending thoracic aorta and reduce the need for surgical reintervention.