FET in Chronic Dissections—Excellent Outcome but Frequent Need for Late Distal Interventions

Background: In patients undergoing FET surgery for chronic aortic dissections (CAD), distal aortic interventions may become necessary to treat the remaining aortic disease. We sought to analyze outcome and rate of reinterventions after initial FET surgery for CAD type A or B.

Methods: From 01/2010 to 03/2024, 78 patients underwent FET surgery for CAD at our center. Follow-up including CT or MRI was performed after 3 and 12 months, and annually thereafter, depending on the progression of the remaining aortic pathology. The indication for distal aortic intervention was consented in an interdisciplinary case conference. All procedural and follow-up data were entered into a database and analyzed retrospectively. Freedom from reintervention and long-term survival were assessed by Kaplan Meier analysis.

Results: Mean age was 55.4 ± 11.8 years with 70.5% male patients. EuroSCORE II was 8.7 ± 8.4%. Underlying heritable thoracic aortic disease was present in 31 patients (39.7%). Concomitant surgery on the aortic root was necessary in 16 patients (20.5%) during the FET procedure and 3 (3.8%) received concomitant coronary artery bypass grafting. Distal anastomosis was performed in aortic arch zone 2 in 57 patients (73.1%). The procedure-related and 30-day mortality rates following FET surgery were 0.6 and 2.6%, respectively. Mean follow-up was 2.5 ± 2.5 years. During the follow-up, 41 patients (52.6%) underwent at least one secondary aortic intervention for exclusion of false lumen perfusion and remaining thoracoabdominal aneurysm. Type of secondary intervention was endovascular in 37 patients. Furthermore, complete thoracoabdominal repair (Crawford procedure) was performed in 3 patients, all suffering from connective tissue disorder. One patient received a biiliacal Y-prosthesis. Freedom from reintervention 1 and 5 years after FET procedure for CAD was 49.8 and 33.7%, respectively. The 5-year survival rates after initial FET surgery were 89.9% in patients without reinterventions versus 77.8% in patients with reinterventions (p = 0.81).

Conclusion: Elective FET surgery for CAD is associated with low rates of early postoperative mortality. Distal aortic interventions after FET surgery for CAD affecting the entire aorta are frequently necessary to exclude false lumen aneurysm. To achieve satisfactory long-term survival rates, regular follow-up, including serial imaging and a multidisciplinary Aortic Center approach, is paramount for early detection and treatment of progression of the aortic pathology.

Publication History

Article published online:
11 February 2025