Aortic & peripheral vascular disease
Frozen elephant trunk for acute type A aortic dissection: long-term outcomes over two decades
Authors' conclusion
In this series spanning two decades, the FET + TAR technique achieved satisfactory long-term survival and freedom from reintervention in patients with ATAAD, showing lower risk of late death, reoperation and distal aortic dilation compared to hemiarch repair.
Study context
- Population
- Patients with acute type A aortic dissection (ATAAD), 2003–2014
- Participants
- 850 patients72 propensity-matched pairs
- Exposure
- FET + TAR vs hemiarch repair
- FET + TARn = 850
- Outcome
- Early and long-term outcomes (operative mortality, survival, freedom from reoperation)
Methodological detailssingle-centre, propensity-score matched comparison
- Single-centre
- Propensity-score matched comparison
Main finding
As reported in the abstract
- Operative mortality
- 8.4% (71/850)
- Survival at 20 years
- 70.0% (95% CI 65.8%-74.0%)
- Freedom from reoperation at 20 years
- 85.4% (95% CI 80.1%-89.4%)
- Competing risks at 15 years: death
- 25%
- Competing risks at 15 years: reoperation
- 13%
- Competing risks at 15 years: reoperation-free survival
- 62%
Observational data: associations, not effects.
Further findings
Risk factors of late death
| HR | P value | |
|---|---|---|
| Cerebrovascular accident | 2.34 | P = 0.031 |
| Visceral ischaemia | 4.12 | P = 0.005 |
Operative mortality, matched comparison · propensity-matched pairs
P = 0.719
Late adverse events (death, reoperation, distal aortic dilation), matched comparison · propensity-matched pairs
P = 0.048
| Outcome | FET + TAR | Hemiarch repair | P value |
|---|---|---|---|
| Freedom from late adverse events, matched comparison · 20 yearsPropensity-matched pairs | 78% (95% CI 58.8%–89.0%) | 45.6% (95% CI 27.7%–61.8%) | P = 0.042 |
Safety
Early complications after FET + TAR
- Spinal cord injury
- 2.5% (21/850)
- Stroke
- 3.5% (30/850)
- Re-exploration for bleeding
- 5.6% (48/850)
- AKI
- 8.7% (74/850)
Original publication
Frozen elephant trunk for acute type A aortic dissection: long-term outcomes over two decades. Eur Heart J. Published 30 January 2026. doi:10.
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