Total Aortic Arch Replacement With the Frozen Elephant Trunk Technique: Influence of Aortic Arch Anomalies

To assess surgical challenges and outcomes associated with arch anomalies in patients undergoing frozen elephant trunk (FET) for acute and chronic dissections.

From January 2007 to January 2024, 401 patients underwent FET procedure in our centre. We included 285 patients with acute type A/B, chronic type A/B, and residual dissection. Patients were divided into normal arch group (n = 216) and arch anomalies group (n = 69), including aberrant right subclavian artery, bovine trunk, arch vertebral artery, and gothic arch.

Overall in-hospital mortality was 15.4% (17.4% in arch anomalies vs 14.8% in arch normal). In-hospital thoracic endovascular aortic repair (TEVAR) occurred in 7.2% (n = 5) of patients with arch anomalies. Stent graft-induced new entry tear at follow-up was 26.1% in arch anomalies vs 17.1% in arch normal group. Long-term survival in the overall patients was not different between the 2 groups (P = .383). In the subgroup of patients treated for chronic aortic dissection, freedom from TEVAR was higher in those with normal arch anatomy (P = .026).

Aortic arch anomalies, especially in chronic dissection, were associated with increased endovascular reintervention. The gothic arch is the most challenging configuration due to frequent stent kinking.