Aortic arch replacement with descending thoracic aorta stenting for chronic dissection: early outcomes

The frozen elephant trunk (FET) is used to treat patients with arch and descending aortic diseases. This study evaluates the early clinical outcomes and postoperative aortic remodelling in patients with chronically dissected aorta who were treated with the FET procedure.

A retrospective analysis of prospectively collected data from 23 patients who underwent aortic arch replacement with descending thoracic aorta stenting using a branched hybrid FET prosthesis at Southampton General Hospital between 2017 and 2022. All patients received Thoraflex™ prostheses. Patient characteristics, surgical outcomes, follow-up data, and postoperative aortic remodelling, including false lumen thrombosis and changes in aortic dimensions, were assessed using CT imaging.

The mean age was 63.8 ± 12.1 years, 17(74%) were men and two patients (9%) had a connective tissue disorder. Ten (43%) had re-do surgery and one patient had concomitant thoracic endovascular aneurysm repair. There was no in-hospital or 30-day mortality. One patient (4%) suffered a stroke and one (4%) developed paraplegia. False lumen thrombosis was achieved in all patients at the level of the stent. The mean follow-up was 3.5 ± 1.8 years. Aortic size stabilized in 91% of patients, with a reduction in false lumen diameter and an increase in true lumen diameter in all patients. Four patients (17%) required further aortic interventions.

The FET technique demonstrates favourable early clinical outcomes and satisfactory aortic remodelling in patients with chronic aortic dissection. The procedure effectively promotes false lumen thrombosis, stabilizes the aortic size and facilitates downstream procedures, if required, therefore making it a viable treatment option.

The study was conducted as a service evaluation, for which local institutional approval was obtained (Service Evaluation Number SEV/0649 obtained on 06 February 2024).