What question did this study set out to answer?

To evaluate if early aortic remodeling identified by CT predicts mid-term outcomes after FET surgery for chronic aortic dissection.

February 13, 2026Open Access

Do early aortic remodeling patterns at 6 months predict mid-term outcomes after frozen elephant trunk for chronic aortic dissection?

Key Points

To evaluate if early aortic remodeling identified by CT predicts mid-term outcomes after FET surgery for chronic aortic dissection.
Analyzed data from 56 patients undergoing total arch replacement with FET at two centers.
Measured changes in aortic diameter using CT at 6 months post-surgery.
Classified patients based on early remodeling patterns as either EPR or ENR.
Tracked outcomes including distal reintervention, dSINE, and overall survival over a 5.4-year follow-up.
64% of patients required distal reintervention by the end of follow-up.
Freedom from distal reintervention was significantly higher in EPR patients (44.6%) compared to ENR patients (6.2%).
dSINE occurred in 46.4% of the cohort, with EPR showing a 65.1% freedom rate compared to 18.2% in ENR.
Overall 5-year survival was 80.0%, with drastic differences between ENR management strategies.

Abstract

Abstract OBJECTIVES To determine whether computed tomography (CT) within 6 months after total arch replacement with a frozen elephant trunk (FET) for chronic aortic dissection predicts mid-term outcomes and informs the timing of distal treatment. METHODS We analyzed 56 consecutive patients who underwent total arch replacement with FET at two centers (2009–2022) and had evaluable 6-month postoperative CT. Early remodelling was defined as the change from baseline to 6 months in the maximal outer-to-outer diameter of the proximal descending thoracic aorta at Level A (Ishimaru zone 3, 20 mm distal to the left subclavian artery, measured on centerline-orthogonal reconstructions). Patients were classified as early positive remodelling (EPR; no increase or a decrease) or early negative remodelling (ENR; ≥1-mm increase). Prespecified outcomes were distal aortic reintervention, distal stent graft–induced new entry (dSINE), and overall survival. RESULTS Mean follow-up was 5.4 years (standard deviation 3.7). Distal reintervention was required in 36/56 patients (64%). At 5 years, freedom from distal reintervention was higher with EPR than with ENR (44.6% vs 6.2%; p = 0.003). dSINE occurred in 26/56 patients (46.4%); 5-year dSINE-free survival was 65.1% (95% confidence interval CI, 39.6–81.9) with EPR versus 18.2% (95% CI, 5.9–35.2) with ENR (p = 0.008). Overall, 5-year survival for the cohort was 80.0% (95% CI, 64.7–89.2). Among ENR patients, 5-year survival was 0% with conservative management versus 40.5% with distal intervention (p 0.001); within EPR, 5-year survival was 65.9% with conservative management versus 85.7% with reintervention (p = 0.210). CONCLUSIONS A 6-month CT provides simple, actionable risk stratification after total arch replacement with FET for chronic aortic dissection. Absence of EPR identifies a high-risk subgroup (ENR) that warrants closer surveillance and timely distal intervention, optimizing follow-up intensity and treatment timing.

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