Aortic arch surgery in real life practice: is Frozen Elephant Trunk always a better option than conventional aortic arch replacement?

Aortic arch surgery in real life practice: is Frozen Elephant Trunk always a better option than conventional aortic arch replacement? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Aortic arch surgery in real life practice: is Frozen Elephant Trunk always a better option than conventional aortic arch replacement? maxime zimmermann, Matteo POZZI, Fadi farhat, marco vola, Jean-francois obadia, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8625513/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Objective: The management of aortic arch disease (AAD) remains complex due to its involvement in multiple aortic segments and the variety of patient presentations. This study aimed to compare the clinical outcomes of conventional aortic arch repair (CAAR) and the frozen elephant trunk (FET) technique across different indications, including acute type A aortic dissection (ATAAD), chronic dissection, and atheromatous aneurysm. Materials and Methods: This retrospective observational single-center study included 102 patients who underwent aortic arch repair between January 2012 and June 2023. Patients were divided into two groups: CAAR (n=45) and FET (n=57). Clinical, surgical, and radiological data were analyzed, including pre- and post-operative CT-angiograms. Primary endpoint was one-year survival, secondary endpoints included post-operative complications, reinterventions, and aortic diameter evolution. Results: Aortic arch surgery was performed in three situations: acute type A aortic dissection, chronic dissection and chronic atheromatous aneurysm. In subgroup analyses, there was no statistical differences between CAAR and FET patients in terms of morbidity and mortality. Reinterventions were more frequent in the FET group (p < 0,05) but demonstrated a more extensive aortic disease (p < 0,05). After CT-angiogram analyses, aortic isthmus and descending aorta diameters were stable in the FET group and increased significantly in the CAAR group. The differences were statistically significant, even in subgroup analyses. Conclusion: The FET technique offers better long-term aortic remodeling and stability, especially in complex aortic pathologies. FET could be considered the standard treatment in specialized centers. cardiac surgery aortic arch aortic dissection Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 24 Mar, 2026 Reviews received at journal 17 Feb, 2026 Reviews received at journal 14 Feb, 2026 Reviews received at journal 14 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers invited by journal 05 Feb, 2026 Editor assigned by journal 21 Jan, 2026 Submission checks completed at journal 21 Jan, 2026 First submitted to journal 17 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8625513","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587701908,"identity":"64bb6cd5-8432-4e11-ad8a-d95a6f8646fc","order_by":0,"name":"maxime zimmermann","email":"","orcid":"","institution":"Hospices Civils de Lyon","correspondingAuthor":false,"prefix":"","firstName":"maxime","middleName":"","lastName":"zimmermann","suffix":""},{"id":587701909,"identity":"bfdf8379-a624-4fa9-825c-2ba535b11461","order_by":1,"name":"Matteo POZZI","email":"","orcid":"","institution":"Hospices Civils de 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replacement?","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cardiac surgery, aortic arch, aortic dissection","lastPublishedDoi":"10.21203/rs.3.rs-8625513/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8625513/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003cbr\u003e\nThe management of aortic arch disease (AAD) remains complex due to its involvement in multiple aortic segments and the variety of patient presentations. This study aimed to compare the clinical outcomes of conventional aortic arch repair (CAAR) and the frozen elephant trunk (FET) technique across different indications, including acute type A aortic dissection (ATAAD), chronic dissection, and atheromatous aneurysm.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective observational single-center study included 102 patients who underwent aortic arch repair between January 2012 and June 2023. Patients were divided into two groups: CAAR (n=45) and FET (n=57). Clinical, surgical, and radiological data were analyzed, including pre- and post-operative CT-angiograms. Primary endpoint was one-year survival, secondary endpoints included post-operative complications, reinterventions, and aortic diameter evolution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAortic arch surgery was performed in three situations: acute type A aortic dissection, chronic dissection and chronic atheromatous aneurysm. In subgroup analyses, there was no statistical differences between CAAR and FET patients in terms of morbidity and mortality. Reinterventions were more frequent in the FET group (p \u0026lt; 0,05) but demonstrated a more extensive aortic disease (p \u0026lt; 0,05). After CT-angiogram analyses, aortic isthmus and descending aorta diameters were stable in the FET group and increased significantly in the CAAR group. The differences were statistically significant, even in subgroup analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe FET technique offers better long-term aortic remodeling and stability, especially in complex aortic pathologies. FET could be considered the standard treatment in specialized centers.\u003c/p\u003e","manuscriptTitle":"Aortic arch surgery in real life practice: is Frozen Elephant Trunk always a better option than conventional aortic arch replacement?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 20:44:07","doi":"10.21203/rs.3.rs-8625513/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-24T15:45:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T10:09:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T01:28:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-14T16:18:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53609684951079025966025411879987034497","date":"2026-02-09T08:16:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"240391247806062472354934486772837852678","date":"2026-02-05T12:07:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63696469221316871419610232708419481544","date":"2026-02-05T10:48:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69616629493493652247346035365480173771","date":"2026-02-05T10:10:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135427206760814589097136689355807591111","date":"2026-02-05T10:10:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-05T09:53:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T03:25:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-22T03:25:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2026-01-17T10:51:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f92fbfc8-bac2-4595-9473-36f44706131b","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T06:53:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 20:44:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8625513","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8625513","identity":"rs-8625513","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}