Aortic arch surgery in real life practice: is Frozen Elephant Trunk always a better option than conventional aortic arch replacement?

Objective: The management of aortic arch disease (AAD) remains complex due to its involvement in multiple aortic segments and the variety of patient presentations. This study aimed to compare the clinical outcomes of conventional aortic arch repair (CAAR) and the frozen elephant trunk (FET) technique across different indications, including acute type A aortic dissection (ATAAD), chronic dissection, and atheromatous aneurysm. Materials and Methods: This retrospective observational single-center study included 102 patients who underwent aortic arch repair between January 2012 and June 2023. Patients were divided into two groups: CAAR (n=45) and FET (n=57). Clinical, surgical, and radiological data were analyzed, including pre- and post-operative CT-angiograms. Primary endpoint was one-year survival, secondary endpoints included post-operative complications, reinterventions, and aortic diameter evolution. Results: Aortic arch surgery was performed in three situations: acute type A aortic dissection, chronic dissection and chronic atheromatous aneurysm. In subgroup analyses, there was no statistical differences between CAAR and FET patients in terms of morbidity and mortality. Reinterventions were more frequent in the FET group (p < 0,05) but demonstrated a more extensive aortic disease (p < 0,05). After CT-angiogram analyses, aortic isthmus and descending aorta diameters were stable in the FET group and increased significantly in the CAAR group. The differences were statistically significant, even in subgroup analyses. Conclusion: The FET technique offers better long-term aortic remodeling and stability, especially in complex aortic pathologies. FET could be considered the standard treatment in specialized centers.