ArticleInterdisciplinary cardiovascular and thoracic surgery2026
Do Early Aortic Remodelling Patterns at 6 Months Predict Mid-Term Outcomes After Frozen Elephant Trunk for Chronic 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
objectivesTo determine whether CT within 6 months after total arch replacement (TAR) with a frozen elephant trunk (FET) for chronic aortic dissection predicts mid-term outcomes and informs the timing of distal treatment.
methodsWe analysed 56 consecutive patients who underwent TAR with FET at 2 centres (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 centreline-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.
resultsMean 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 = .003). dSINE occurred in 26/56 patients (46.4%); 5-year dSINE-free survival was 65.1% (95% CI, 39.6-81.9) with EPR versus 18.2% (95% CI 5.9-35.2) with ENR (P = .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 < .001); within EPR, 5-year survival was 65.9% with conservative management versus 85.7% with reintervention (P = .210).
conclusionsA 6-month CT provides simple, actionable risk stratification after TAR 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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