Mid-term outcomes of frozen elephant trunk versus hemiarch in acute of type A aortic dissections.

Background: The aim of this study was to compare the postoperative morbidity and mortality between total replacement of the aortic arch using the frozen elephant trunk technique versus replacement of the hemiarch in patients with acute type A aortic dissection and dissection of arch branch vessels without cerebral malperfusion.

Methods: Between January 2015 and April 2023, 156 patients with acute type A aortic dissections were treated in our Center. Only patients with TAE2M2- (Type A or Type non-A non-B, with entry tear in arch aorta extend to arch branch vessels dissection without symptoms) were included. Patients were analyzed according to the surgical techniques: FET or hemiarch replacement.

Results: Forty-two patients were included in our study. In hospital mortality was similar between the groups (FET: 12%, Hemiarch: 0%; P=0.2593). Survival at 5 years was 88% in the FET group and 94.1% in the hemiarch group (P=0.5243). Patients treated with FET showed a higher incidence of additional procedures on the remaining aorta (36.4% versus 0%, P=0.0056). Stroke with permanent neurologic dysfunction were similar between the groups (FET 8% and Hemiarch 11.8%; P=1.0000).

Conclusions: FET and hemiarch replacement showed similar short- and mid-term results. The FET technique offers advantages for distal aorta protection and future endovascular interventions but is associated with longer circulatory arrest and higher transfusion requirements. No significant survival or neurological benefits were observed for FET over ODA in the absence of malperfusion.