Comparison of 3 Surgical Procedures for DeBakey Type I Acute Aortic Dissection: When Is Frozen Elephant Trunk Recommended?

OBJECTIVES

To compare 3 surgical procedures (ascending aortic replacement [AAR], total arch replacement with conventional elephant trunk [cET], or frozen elephant trunk [FET]) for acute type A aortic dissection (ATAAD). Additionally, the AAR group was stratified by the presence or absence of arch vessel dissection (AVD), and outcomes were evaluated among the 4 groups.

METHODS

Patients who underwent AAR or total arch replacement with cET or FET for DeBakey type I ATAAD between December 2006 to December 2024 at 5 institutions were included. The cumulative incidence of aortic events, defined as aortic enlargement, aortic reintervention, or aorta-related adverse events, was compared between procedures using pairwise comparisons adjusted by inverse probability of treatment weighting.

RESULTS

Of the total 334 patients, 136 with AAR, 94 with cET, and 104 with FET were enrolled. The 5-year cumulative incidence of aortic events was lower for FET compared with that for cET and AAR (AAR: 57.7% vs cET: 49.1% vs FET: 25.2%). Further stratification of the AAR group revealed worse outcomes for AAR with AVD (hazard ratio, 2.25; 95% confidence interval, 1.28-3.95; P = .005). FET showed superior outcomes compared with all other groups, including AAR without AVD (hazard ratio, 0.25; 95% confidence interval, 0.09-0.67; P = .006).

CONCLUSIONS

FET for ATAAD was associated with a lower incidence of aortic events compared with other procedures. FET may be a beneficial option for ATAAD with AVD, which is associated with a higher incidence of aortic events after AAR.