ArticleInterdisciplinary cardiovascular and thoracic surgery2026
Impact of the Elephant Trunk on Distal Remodelling After Surgery for Acute Type I Aortic Dissection.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesFor surgical repair of acute type I aortic dissection, total arch replacement (TAR) with a frozen elephant trunk (FET) has been known to result in better long-term remodelling of a residual false lumen. This study was designed to investigate the impact of the elephant trunk by comparing long-term remodelling features among different extents and strategies of aortic replacement.
methodsWe conducted a single-centre retrospective analysis of patients who underwent surgical repair for acute type I aortic dissection from January 2004 to June 2022. Patients were categorized based on the surgical strategy employed: non-TAR, conventional TAR, TAR with a classic elephant trunk (CET) and TAR-FET. The primary outcomes were positive remodelling of the residual false lumen and composite aortic events, with secondary outcomes focusing on early postoperative results.
resultsA total of 327 patients were included. TAR, when combined with the insertion of an ET, whether it was stented or not, significantly promoted favourable aortic remodelling (P < .001). Compared with TAR-CET, the FET group tended towards faster false lumen thrombosis and regression, albeit without a significant difference in ultimate remodelling rates; 1-year and 5-year rates of proximal descending false lumen thrombosis were 85.4% (95% confidence interval [CI], 69.2-100) and 90.3% (95% CI, 75.9-100), respectively, after TAR-FET; additionally, these aforementioned rates were 65.7% (95% CI, 54.7-76.6) and 81.9% (95% CI, 71.8-91.9), respectively, after TAR-CET. No significant differences were observed in early postoperative outcomes or overall survival.
conclusionsThe favourable remodelling of the residual false lumen after TAR-FET shown in this study is in line with results from previous studies. CET might be a reasonable alternative to FET according to the individual patient risk profiles and institutional logistics situation.
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