Predictors of Distal Stent Graft-Induced New Entry after Frozen Elephant Trunk in Acute Type A Aortic Dissection.

OBJECTIVES

Distal stent graft-induced new entry (d-SINE) is a significant complication of frozen elephant trunk (FET) for acute Stanford type A aortic dissection (ATAAD). This study aimed to identify the predictive factors for d-SINE occurrence.

METHODS

Patients who underwent FET procedures for ATAAD at our institution between January 2015 and December 2024 were retrospectively analysed. Patients were classified into d-SINE positive and d-SINE negative groups, and predictive factors were identified using Fine and Gray competing risk regression.

RESULTS

A total of 84 consecutive patients were included. The overall incidence of distal stent graft-induced new entries was 11.9% (10/84). Distal stent graft-induced new entry occurred at a mean of 102 days (standard deviation 69) postoperatively. A preoperative descending aortic diameter ≥33 mm was an independent predictive factor (subdistribution hazard ratio, 6.11; 95% confidence interval, 1.176-31.740; P = .031).

CONCLUSIONS

A preoperative descending aortic diameter ≥33 mm was identified as a key predictor of d-SINE following FET for ATAAD. This finding may help identify high-risk patients who require more intensive imaging surveillance after surgery.

CLINICAL REGISTRATION NUMBER: E250127-4.