• Kai Zhang, Juntao Qiu, Jinlin Wu, Chenyu Zhou, Yumeng Ji, Enzehua Xie, Shiqi Gao, Bin Hou, Han Li, Qian Chang, Xiangyang Qian, Xiaogang Sun, Lizhong Sun, and Cuntao Yu.
• Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing 100037, China.
• J. Thorac. Cardiovasc. Surg. 2024 Nov 25.

ObjectiveThe optimal surgical approach for acute type A aortic dissection (ATAAD) involving the aortic arch remains controversial. This study aims to evaluate the long-term outcomes of ATAAD treated with total arch replacement combined with frozen elephant trunk implantation (TAR with FET) in a large single-center cohort.MethodsFrom 2010 to 2022, ATAAD patients who received TAR with FET at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Logistic regression and Cox regression analyses were performed to identify risk factors for operative mortality, long-term mortality, and reoperation, respectively.ResultsA total of 1672 patients underwent TAR with FET, of whom 79.9% (1336/1672) were male with a median age of 48 years. The operative mortality rate was 6.3% (105/1672). The 10-year survival rate was 81.4%, and the most extended follow-up was over 13 years. Among the survivors, 89.7% (1303/1453) had complete self-care ability and were able to engage in general physical work. The 10-year cumulative incidence of reoperation was 13.3%. Multivariable logistic regression analysis revealed that male gender was associated with a reduced risk of operative death (odds ratio 0.95, 95% confidence interval 0.92-0.98) and long-term death (hazard ratio 0.68, 95% confidence interval 0.48-0.96).ConclusionsTAR with FET demonstrates acceptable operative mortality and promising long-term outcomes for ATAAD. Females face higher risks of operative and long-term mortality compared to males. TAR with FET provides patients with encouraging long-term quality of life and is advisable for ATAAD in experienced centers.Copyright © 2024. Published by Elsevier Inc.

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