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Long-term outcomes of frozen elephant trunk for non-A non-B aortic dissection: a comparative analysis based on entry
1Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Background:
Non-A non-B aortic dissection (NANB-AD) is a rare and heterogeneous subtype involving the aortic arch and descending aorta without ascending aortic involvement, and its optimal management remains controversial, particularly in the setting of different primary entry tear locations. Evidence on the early and long-term outcomes of total arch replacement combined with frozen elephant trunk (TAR with FET) in NANB-AD is still limited. This study aimed to evaluate the early and long-term outcomes of TAR with FET in NANB-AD patients with different primary tear locations.
Methods:
We retrospectively collected data from patients with NANB-AD who underwent TAR with FET between 2010 and 2022. Patients were stratified into two groups based on the primary tear location: the arch entry group and the descending entry group. Clinical data were collected and long-term follow-up was conducted through August 2024. Primary outcomes included survival, freedom from aortic reintervention, and quality of life measured by activity of daily living (ADL). Competing risk analysis was conducted to assess postoperative mortality and aorta-related reintervention.
Results:
A total of 63 patients with NANB-AD were included, with 31 patients in the arch entry group and 32 patients in the descending entry group. Early outcomes included 2 perioperative deaths (3%) and 2 cases of permanent neurological deficit (3%). After a median follow-up of 4 years, 2 additional all-cause deaths (3%) occurred. Five patients (8%) required aortic-related reinterventions, including 2 thoracic endovascular aortic repairs (TEVARs) and 3 thoracoabdominal aortic replacements. Kaplan-Meier analysis demonstrated comparable long-term survival between groups (P=0.30), and competing risk model analysis showed no significant difference in reintervention rates. Functional assessment revealed that 54 patients (91.5%) were able to resume standard physical activities postoperatively.
Conclusions:
TAR with FET represents an effective surgical strategy for NANB-AD with favorable early and long-term outcomes. The anatomical location of the primary tear does not significantly influence surgical efficacy, suggesting that this approach is suitable for NANB-AD regardless of entry tear position.
