Conventional Frozen elephant trunk (FET) repair for acute type A dissection (ATAD) with zone 3 delivery promotes false lumen (FL) thrombosis. Simplified delivery FET (SD-FET) technique is characterised by proximalization in zone 0 and a stent length of 100mm.

The aim of the study was to assess the effects of the proximalization on mid-term aortic remodelling.

Retrospective analysis of a prospectively maintained database of 30 consecutive patients treated with SD-FET in a single centre between September 2018 and January 2023. Maximum aortic diameters of residual dissection (true lumen [TL], FL and total aortic diameter, and FL status) were assessed in 4 zones using centerline reconstructions (Aquarius) in each imaging (CTA) performed during follow-up (FU). Demographic, aortic and non-aortic events were recorded. Mixed models were used to analyse repeated diameters measurement over time.

Mean FU was 15.8 months (1-38), early survival was 87%. During FU, 2 patients required aortic reintervention (TEVAR) and 1 patient died after 4 months due to a rupture of the coeliac trunk during follow-up. Over a 12-month period, we observed positive remodelling of the proximal descending aorta with a significant decrease in FL diameter by 10.2mm, which was associated with enlargement of the TL and promotion of FL thrombosis, no significant remodelling at the level of the distal thoracic aorta and negative remodelling at the level of the coeliac [GG1] trunk with a trend towards an increase in FL diameter of 3mm. The infra-renal aorta was stable over time (Figure 1).

Proximalization and its advanced benefits must not undermine the long-term strength of FET procedure. Our results suggest similar aortic remodeling of the residual dissection compared to the literature, with sustained diameter reduction and FL thrombosis in the proximal and median descending aorta.