• Haoyu Gao, Bowen Zhang, Xuyang Chen, Yanxiang Liu, Cuntao Yu, and Xiaogang Sun.
• Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
• J. Thorac. Cardiovasc. Surg. 2024 Aug 6.

ObjectivePatients who underwent previous frozen elephant trunk (FET) implantation for Stanford type A aortic dissection (AAAD) remain at risk for secondary intervention due to unsuccessful distal aortic remodeling (DAR). We aimed to investigate the impact of DAR on early outcomes in patients who underwent two-stage thoracoabdominal aortic (TA) repair.MethodsOne hundred and six patients who previously underwent FET implantation and TA repair between October 2014 and December 2022 were enrolled in this study. The extent of DAR was evaluated, including aortic diameter, area ratio of the false lumen (FL)/aortic lumen (AoL) and patency of the FL at three levels of the aorta. Logistic regression analyses were performed to investigate the risk factors for early outcomes.ResultsThe Ao diameter at the distal FET was significantly larger in patients who died early than in surviving patients (79.19±22.89 mm vs. 46.84±19.17 mm, adjusted P = 0.001). The optimal cutoff value for the Ao diameter at the distal FET was 60 mm. Patients with an Ao diameter ≥ 60 mm at the distal FET had worse early outcomes (P <0.05), including prolonged intubation, early death and postoperative complications. The Ao diameter at the distal FET was identified as a significant risk factor for early death in patients undergoing TA repair.ConclusionsPatients undergoing TA repair with an Ao diameter ≥ 60 mm at the distal FET have worse early outcomes. Moreover, an Ao diameter at the distal FET is a significant risk factor for early death in patients undergoing TA repair.Copyright © 2024. Published by Elsevier Inc.

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