Frozen Elephant Trunk Does Not Increase Incidence of Paraplegia in Patients With Acute Type A Aortic Dissection

The International Aortic Arch Surgery Study Group assessed the safety of total arch replacement (TAR) with frozen elephant trunk (FET) for acute type A aortic dissection (ATAAD) with respect to the risks of operative mortality, stroke, and paraplegia.
Data from 978 patients who underwent total aortic arch replacement for ATAAD with or without FET placement were analyzed. In propensity-score matching, there were no significant differences between TAR plus FET versus isolated TAR in terms of permanent neurological deficits (11.9% versus 10.1%, p = 0.59) and spinal cord injury (4.0% versus 6.3%, p = 0.52). Post-hoc propensity-score stratification showed that FET was associated with a statistically significantly lower mortality risk (OR = 0.47, 95% CI 0.239-0.929, p = 0.03).
These results show that the use of FET for ATAAD does not appear to increase the risk of paraplegia in appropriately selected patients at experienced centers.