Total Aortic Arch Replacement With the Frozen Elephant Trunk Technique: Influence of Aortic Arch Anomalies

OBJECTIVES: To assess surgical challenges and outcomes associated with arch anomalies in patients undergoing frozen elephant trunk (FET) for acute and chronic dissections. METHODS: From January 2007 to January 2024, 401 patients underwent FET procedure in our centre. We included 285 patients with acute type A/B, chronic type A/B, and residual dissection. Patients were divided into normal arch group (n = 216) and arch anomalies group (n = 69), including aberrant right subclavian artery, bovine trunk, arch vertebral artery, and gothic arch. RESULTS: Overall in-hospital mortality was 15.4% (17.4% in arch anomalies vs 14.8% in arch normal). In-hospital thoracic endovascular aortic repair (TEVAR) occurred in 7.2% (n = 5) of patients with arch anomalies. Stent graft-induced new entry tear at follow-up was 26.1% in arch anomalies vs 17.1% in arch normal group. Long-term survival in the overall patients was not different between the 2 groups (P = .383). In the subgroup of patients treated for chronic aortic dissection, freedom from TEVAR was higher in those with normal arch anatomy (P = .026). CONCLUSIONS: Aortic arch anomalies, especially in chronic dissection, were associated with increased endovascular reintervention. The gothic arch is the most challenging configuration due to frequent stent kinking.