Aortic remodeling after zone 0 simplified delivery frozen elephant trunk (SD-FET) technique in acute aortic dissection: one-year clinical and morphological results in a single centre

Background: The simplified delivery frozen elephant trunk (SD-FET) technique enables a one-step repair of type A acute aortic dissection (AAD) with stent proximalisation and very short normothermic circulatory arrest. This study reports early and 1-year clinical outcomes together with aortic remodelling in the residual dissected aorta.

Methods: Thirty consecutive patients underwent SD-FET for AAD between 2018 and 2023. Preoperative, postoperative, 1-year follow-up computed tomography scans were analyzed. True lumen (TL), false lumen (FL), and total aortic diameters were measured in four segments (proximal descending, distal descending, coeliac trunk, infra-renal) using the centerline method. Aortic remodelling was classified as positive, stable, or negative. Early and mid-term outcomes were assessed, including mortality, neurologic complications, and aortic reinterventions.

Results: Four patients (13%) died in-hospital, and four (13%) sustained postoperative stroke; no spinal cord injury occurred. During follow-up, one patient died of an aortic event and two required secondary reinterventions for downstream enlargement, yielding an overall 1-year freedom from reintervention of 92.5% [95% confidence interval (CI): 83–100%]. At the proximal descending aorta, TL increased and FL decreased significantly at 3 months and 1 year (P<0.001), with 92% of patients showing positive or stable remodelling. At the distal descending aorta and coeliac level, positive/stable remodelling was observed in 53% and 63% of cases, respectively, whereas infra-renal changes were limited.

Conclusions: SD-FET simplifies total arch repair for AAD, reduces circulatory arrest under normothermia, and achieves acceptable early results. One-year clinical outcomes and remodelling are comparable to conventional FET, may supports its safety and efficacy, though larger cohorts and longer follow-up remain warranted