Outcomes of fenestrated frozen elephant trunk technique in 150 patients with acute type A aortic dissection

Objective: The fenestrated frozen elephant trunk (FET) technique provides proximalization of distal anastomosis and antegrade blood flow into supra-aortic vessels through fenestration in a FET. We investigated the outcomes of the fenestrated FET technique in acute type A aortic dissection.

Methods: We evaluated 150 patients who underwent arch repair using the fenestrated FET technique for acute type A aortic dissection between July 2014 and January 2023. FET was deployed under hypothermic circulatory arrest and manually fenestrated under direct vision on the supra-aortic vessel aspect. Fenestration was performed for the left subclavian artery alone in 139 patients, 2 supra-aortic vessels in 9 patients, and total supra-aortic vessels in 2 patients. Fixation around fenestration site for endoleak prevention was performed in 48 patients.

Results: The overall 30-day mortality rate was 4.7% (7 out of 150). Two patients developed paraparesis. Adequate blood flow into the supra-aortic vessels through fenestrations were confirmed in all patients at discharge. The false lumen thrombosis rate at the distal edge of FET was 96.6%. The median follow-up period was 28 months. The 1-year and 3-year overall survival rate was 89.1% and 84.5%, respectively. During the follow-up period, neither fenestration occlusion nor stroke was noted in the cerebral area perfused via the fenestration. Distal stent graft-induced new entry was noted in 2 patients.

Conclusions: The fenestrated FET technique is a straightforward and secure procedure for selected patients with acute type A aortic dissection. This technique can facilitate arch repair.