Stent versus Trunk: Who Wins the Aortic Tug-of-War in Type A Dissection? A Systematic Review and Single-Arm Meta-Analysis

Abstract

Background

The frozen elephant trunk (FET) and Ascyrus Medical Dissection Stent (AMDS) are hybrid techniques used in managing acute type A aortic dissection (ATAAD). This systematic review and meta-analysis compared their perioperative outcomes, aortic remodeling, and incidence of distal anastomotic new entry (DANE).

Methods

A comprehensive search yielded 611 studies; after screening, 68 were included—59 on FET and 9 on AMDS—covering 7,420 patients (7,070 FET; 350 AMDS). The primary outcome was DANE incidence. Secondary outcomes included operative time, false lumen thrombosis, ICU/hospital stay, and 30-day/in-hospital mortality.

Results

DANE incidence was 7% in both groups. FET was associated with shorter operative times (353–369 vs. 422 minutes), higher false lumen thrombosis rates (88–89% vs. 84%), and longer hospital stays (17–19 vs. 9–11 days). AMDS had longer ICU stays (7.7–8.5 vs. 5.3–7.5 days). Mortality rates were similar (FET: 8–9%; AMDS: 7–10%). Critically, neurological complication rates were substantially higher with AMDS (33% [15–53%]) compared with FET (13% [10–16%]). However, the evidence base for AMDS remains limited (9 studies) compared with FET (59 studies). Egger's test showed publication bias in FET studies for DANE and length of stay outcomes; bias assessment for AMDS was limited by study number.

Conclusion

Limited available evidence suggests that FET and AMDS show similar DANE and mortality outcomes. FET may favor better remodeling and a safer neurological profile, but longer hospitalization, though high heterogeneity and limited AMDS data underscore the need for robust comparative trials.

Keywords

acute type A aortic dissection - frozen elephant trunk - Ascyrus Medical Dissection Stent - distal anastomotic new entry - false lumen thrombosis - systematic review - meta-analysis - aortic surgery outcomes - perioperative mortality - hybrid aortic repair

Declaration of GenAI Use

Artificial intelligence (AI) assistance (ChatGPT, OpenAI) was used solely for language proofreading and grammar correction during the preparation of this manuscript. No part of the data analysis, interpretation, or intellectual content was generated or influenced by AI tools. All scientific conclusions and content are the authors' original work.

Data Availability Statement

The data are available from the population on databases. All data generated or analyzed during this study are included in this published article (and its supplementary information files). Additional de-identified data may be available from the corresponding author upon reasonable request, subject to institutional approval and ethical considerations.

Publication History

Received: 15 August 2025

Accepted: 02 November 2025

Accepted Manuscript online:
05 November 2025

Article published online:
04 December 2025

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