Efficacy of total arch replacement with frozen elephant trunk in patients with acute type A aortic dissection.

Objective: To compare the outcomes of classical elephant trunk (CET) + total arch replacement (TAR) and frozen elephant trunk (FET) + TAR using propensity score matching analysis. Methods: Between 2012 and 2023, 370 patients who underwent TAR were divided into 2 groups based on their elephant trunk type: the CET group (153 patients; 92 men; mean age, 66 ± 13 years) and FET group (217 patients; 116 men; mean age, 64 ± 12 years). Among these patients, 124 from each group were matched using propensity scores to account for differences in patient characteristics. Results: Early outcomes, such as mortality and morbidity, were similar between the unmatched and matched cohorts. Circulatory arrest time was significantly shorter in the CET group, even after propensity score matching. In matched cohorts, the FET group had significantly higher rates of freedom from dissection-related distal aortic reoperation at 3 years and 5 years (87% and 85%, respectively, in the CET group and 96% and 96%, respectively, in the FET group; P = .008). Cox regression analysis identified the FET procedure (hazard ratio, 0.20; P = .008) is an independent positive inhibitory factor of distal aortic reoperation. Serial sizing analysis revealed that the aortic diameter at the level of the celiac artery was significantly smaller in the FET group even 5 years after the initial surgery. Conclusions: FET + TAR has potential as the first option for improved mid-term outcomes after surgery for type A acute aortic dissection.