Stent part anastomosis reduces distal stent graft-induced new entry after frozen elephant trunk.

Objectives: Distal stent graft-induced new entry is a major complication after frozen elephant trunk procedure for type A acute aortic dissection. We investigated the impact of anastomosis location on this complication.

Methods: We reviewed 58 patients who underwent total arch replacement using frozen elephant trunk technique (2015-2023). Patients were divided by anastomosis location: Stent group (n = 24; anastomosis at stent part) and Fabric group (n = 34; anastomosis at graft part). We assessed early complications and mid-term distal aortic events during the follow-up.

Results: Patient characteristics were similar between groups. Early distal stent graft-induced new entry occurred in none of the Stent group versus 6 patients (18%) in the Fabric group (p = 0.04). Both groups showed similar false lumen thrombosis at arch and descending aorta. Freedom from distal aortic events at 1, 3, and 5 years was 100%, 81%, 81% (Stent group) versus 79%, 67%, 33% (Fabric group) (p = 0.049).

Conclusions: Anastomosis at the stent part during frozen elephant trunk procedure reduced distal stent graft-induced new entry and improved mid-term outcomes. In distal anastomosis, the fabric should be as short as possible.