SRS346 - Aggressive management of Stanford type B aortic dissection using the frozen elephant trunk procedure

Background Surgical intervention is generally reserved for complicated Stanford Type B aortic dissection (TBAD) and mostly performed endovascularly. We aim to evaluate an aggressive approach using the frozen elephant trunk (FET) procedure in TBAD patients who were not ideal candidates for endovascular intervention. Methods 23 patients with TBAD underwent FET from May 2020 to Jan 2025 and were subgrouped into Acute (10/23) or Chronic (13/23) dissection categories. Indications for surgical intervention included pain, malperfusion, expansion or leak. FET devices included the Thoraflex Hybrid (20) and Evita Open Neo (3). Maximum stent length was 150 mm. Results Mean age was 57.1 ± 16.6 years [acute 56.3 ± 20.8 versus chronic 57.7 ± 13.5 years, P = 0.832]. 61% were male and significantly more in the chronic group [11/14 versus 3/14, P = 0.012]. All patients were hypertensive and 3 had connective tissue disorders. Spinal drain was used in 17 patients. Pain was the most prevalent indication in Acute patients (50%) and size in Chronic patients (53.8%), P = 0.089. 60% of Acute patients had emergent operations versus none in the Chronic group (P = 0.002). Acute patients had significantly longer hospital length of stay [20 (8–94) versus 11 (5–42) days, P = 0.047] and higher mortality [30% versus 15.4%, P = 0.367]. Remodelling at aortic zones 3–4 showed favourable rates of false lumen thrombosis on follow-up but distal remodelling remained suboptimal. Further downstream interventions were performed in 13 patients (56.5%), of which 9 were endovascular, with no significant difference between chronicity groups (P = 0.402). Conclusions Aggressive intervention involving FET should be reserved for selected patients with long-term follow-up.