Aortic reinterventions following reoperative frozen elephant trunk aortic arch replacement for the treatment of residual type A aortic dissection.

OBJECTIVES

The optimal treatment strategy for residual Type A aortic arch dissections after ascending aortic replacement remains debated. This study evaluated the frequency and outcomes of aortic reinterventions after reoperative total arch replacement with frozen elephant trunk (FET) implantation for residual Type A aortic dissection.

METHODS

Between April 2015 and March 2025, 116 patients underwent elective redo arch replacement using the FET technique for residual Type A dissection at 6 European aortic centers. Incidence, procedural characteristics, and outcomes of patients requiring downstream aortic reinterventions were retrospectively analyzed.

RESULTS

In-hospital mortality following FET implantation was 5% (n = 6). Among 110 hospital survivors, 43 patients (39%) required at least 1 aortic reintervention within 48 months: thoracic or abdominal endovascular aortic repair in 36 (80%), graft replacement in 2 (4.4%), and open thoracoabdominal replacement in 4 (9%). No spinal cord injury or disabling stroke occurred postoperatively; 3 patients (6%) died within 30 days of reintervention. After discharge, a second reintervention was necessary in 7 patients (16%), involving endovascular repair in 4 (57%) and open thoracoabdominal replacement in 3 (43%). The cumulative risk of any reintervention was 31.0% (95% CI, 23.1%-40.6%) at 2 years and 55.4% (95% CI, 42.0%-66.9%) at 4 years, whereas overall survival after FET was 87.8% (95% CI, 81.1%-95.1%) and 82.0% (95% CI, 72.1%-93.3%) at 2 and 4 years, respectively.

CONCLUSIONS

Reoperative arch replacement with FET yields favorable survival but is accompanied by a substantial need for staged downstream aortic reinterventions, most of which can be managed endovascularly, underscoring the importance of structured long-term imaging surveillance.