# Do Early Aortic Remodelling Patterns at 6 Months Predict Mid-Term Outcomes After Frozen Elephant Trunk for Chronic Aortic Dissection?

## TL;DR

This study shows that aortic changes seen on CT scans within 6 months after a specific heart surgery can predict long-term outcomes and guide treatment timing.

## Contribution

The study introduces a new method to predict mid-term outcomes after frozen elephant trunk surgery using early aortic remodeling patterns.

## Key findings

- Patients with early positive remodelling had significantly better 5-year freedom from distal reintervention.
- Early negative remodelling was associated with worse survival when managed conservatively.
- A 6-month CT scan can help identify high-risk patients needing closer monitoring and timely intervention.

## Abstract

To 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.

We 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.

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 = .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).

A 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.

In patients with chronic aortic dissection, total arch replacement (TAR) with a frozen elephant trunk (FET) is an established surgical option, particularly for those with residual dissection after prior type A repair or anatomy unsuitable for thoracic endovascular aortic repair (TEVAR).