Abstract 4363444: Long-term outcomes of extensive aortic arch repair versus endovascular treatment in non-A non-B aortic dissection

Objective: This study presents a single-center retrospective analysis evaluating the long-term outcomes of patients with non-A non-B aortic dissection who underwent either total arch replacement with frozen elephant trunk (TAR with FET) or thoracic endovascular aortic repair (TEVAR). Methods: From 2010 to 2022, patients with non-A non-B aortic dissection who received TEVAR or TAR with FET were selected for clinical data collection and long-term follow-up. Baseline characteristics were balanced using inverse probability weighting. Result: A total of 186 patients were included, with 123 in the TEVAR group and 63 in the FET group. No significant difference in 30-day mortality was observed between the FET and TEVAR groups in both unadjusted and inverse probability weighting analyses (P > 0.05). The FET group, however, consistently showed higher rates of continuous renal replacement therapy (11.6% vs 0.53%, P＜0.01) and prolonged intensive care unit stay (81.2 ± 70 h vs 38.3 ± 51.7 h, P＜0.01). Kaplan-Meier curve analysis showed no significant difference in overall long-term survival (P > 0.05), but landmark analysis revealed that after 6 years post-operation, the FET group had significantly higher survival rates (P＜0.01). Besides, there was no significant difference in aortic-related reintervention between groups (P > 0.05). Conclusion: Regarding early prognosis, it is difficult to determine the superiority between these two approaches. However, from a long-term perspective, TAR with FET represents a more effective treatment strategy compared to TEVAR for patients with non-A non-B type aortic dissection.