Branched stented anastomosis frozen elephant trunk repair reduces operative time and transfusion requirements in acute type A aortic dissection.

BACKGROUND: In acute type A aortic dissection (AADA) patients, total arch replacement (TAR) using the frozen elephant trunk (FET) technique has been adopted in emergencies to promote distal false lumen (FL) thrombosis. However, TAR is technically demanding and is associated with prolonged operative time and increased intraoperative blood transfusion. We previously reported the branched stented anastomosis frozen elephant trunk repair (B-SAFER) technique. Comparative data versus conventional TAR (cTAR) adjusted for disease severity remain limited. Here we compared the early surgical outcomes of TAR using B-SAFER versus cTAR in AADA. METHODS: This retrospective, multicenter, nonrandomized study included patients with AADA and a patent FL who underwent emergency TAR using B-SAFER (n = 63) and cTAR (n = 75). Propensity score matching based on EuroSCORE and JapanSCORE identified 48 matched pairs. After matching, 16 patients (33%) in the comparator group underwent conventional TAR without an FET device because of institutional practice patterns or device-related constraints. RESULTS: The 30-day mortality was 7.3% overall (7/96), with no significant difference between the groups (6.2% for B-SAFER vs 8.3% for cTAR; P > .999). Spinal cord ischemia occurred in 0% versus 4.2% (P = .153). All operative time metrics were significantly shorter with B-SAFER (all P ≤ .024). Transfusion requirements for red blood cells, fresh frozen plasma, and platelets were all significantly lower (all P < .001). CONCLUSIONS: In propensity score-matched patients with AADA, TAR using B-SAFER was safe and reproducible, with reduced operative times and transfusion requirements compared to cTAR.