Early and mid-term outcomes of the fenestrated versus standard frozen elephant trunk technique for acute type A aortic dissection.

OBJECTIVE: This study compared early and mid-term outcomes of the fenestrated and standard frozen elephant trunk (FET) techniques in patients undergoing surgery for acute type A aortic dissection (ATAAD). METHODS: This retrospective study included 62 consecutive patients who underwent total arch replacement with the FET technique for ATAAD between June 2020 and February 2025 at our institution. The patients were divided into the fenestrated FET (n = 35) and standard FET (n = 27) groups. Early and mid-term outcomes, including all-cause mortality and aortic reintervention, were compared between groups. RESULTS: Baseline characteristics were similar between the groups. The fenestrated FET group had a significantly shorter operative time (median: 298 vs. 373 min, P = 0.004), cardiopulmonary bypass time (183 vs. 230 min, P = 0.004), and aortic cross-clamp time (123 vs. 165 min, P = 0.001) than the standard FET group. Distal anastomosis was more frequently performed at zone 2 in the fenestrated FET group and in zone 3 in the standard FET group. The postoperative intubation time was shorter in the fenestrated FET group than in the standard FET group (P = 0.040). Transient paraparesis occurred in two patients in the fenestrated FET group. Operative mortality was 5.7% in both groups. Freedom from aortic reintervention at 2 years was 89.5% in the fenestrated FET group and 78.8% in the standard FET group (P = 0.832), and 2-year survival was 87.1% vs. 74.2%, respectively (P = 0.332). CONCLUSIONS: The fenestrated FET technique in ATAAD surgery has shorter operative and intubation times than the standard FET technique without compromising early outcomes or mid-term survival and reintervention rates.