Clinical Results of a New Hybrid Aortic Arch Graft for the Treatment of Multisegmental Thoracic Aortic Disease: A Comparative Study

Background: The frozen elephant trunk (FET) technique is used to extend the open aortic arch surgery into the descending aorta by using hybrid grafts with a non-stented and a stented vascular graft. The aim of the single center retrospective study was the evaluation of the clinical results of a new hybrid graft for FET surgery in comparison to the previously established FET grafts.

Methods: From January 2020 to Mai 2024, 163 patients underwent FET surgery for acute or chronic aortic disease as one- or two-staged treatment. The new hybrid graft was used in 120 (Group A) and the previous graft in 43 (Group B) patients. The surgical management was similar in both groups including the establishment of antegrade selective cerebral perfusion, moderate hypothermia, four-site perfusion, and the guidance of stent-graft deployment by angioscopy.

Results: The age of patients was 61.4 ± 11.3 years, similar in both groups (p = 0.155). Between Group A versus Group B the indication for surgery was acute (59.2% versus 67.4%, p = 0.339) or chronic (16.7% versus 7%, p = 0.117) aortic dissection or aortic aneurysm (24.2% versus 25.6%, p = 0.853), respectively. A straight configurated hybrid graft was used in 93.3% of Group A and in 93.0% of Group B patients (p = 1.000). The distal FET anastomosis was performed in aortic arch Zone 2 in 80.4% in both groups (p = 0.179). In the descending aorta, additional covered or uncovered endovascular stents were used in 21.7% of Group A versus 20.9% of Group B patients for extension of the stented hybrid graft portion downstream (p = 1.000). The 30-day mortality was 5.0% in Group A versus 9.3% in Group B (p = 0.458). In Group A versus Group B, stroke occurred in 5.0% versus 4.7% (p = 1.000) and paraplegia in 2.5% versus 2.3% (p = 1.000), respectively. In follow-up, computed tomography imaging demonstrated the exclusion of the descending aorta disease up to aortic segment Zone 5 in 92.3% of Group A and 96.4% of Group B patients (p = 0.673). More distally, a residual aortic disease was observed in 55.1 and 60.7% (p = 0.609), respectively. The incidence of distal stent-graft induced new entry was 6.4% in Group A and 7.1% in Group B (p = 1.000).

Conclusion: The new generation of hybrid graft for FET surgery can be used safely with similar results in comparison to the previously established FET grafts. In follow-up, recurrent computed aortic imaging is recommended to exclude progress of the residual aortic disease and a new stent-graft related aortic event.

Publication History

Article published online:
11 February 2025