Outcomes of Frozen Elephant Trunk Surgery in Patients with Hereditary Thoracic Aortic Disease: A Propensity Score Matched Analysis

All articles of this category (opens in new window) Background: Frozen Elephant Trunk (FET) surgery is a well-established treatment option for complex aortic arch disease. However, the independent impact of heritable thoracic aortic disease (HTAD) on surgical outcomes remains insufficiently defined. This single-center study, therefore, aimed to evaluate whether postoperative and early outcomes following FET procedures differ between patients with and without genetically tested HTAD. Methods: In-hospital database was retrospectively screened for patients who underwent FET surgery at our center. A 1:1 propensity score matching (PSM) was performed, creating a balanced cohort of genetically verified HTAD and non-HTAD patients. The PSM model included age, surgical indication (aneurysm or chronic dissection), and renal function. Long-term freedom from re-operation or re-intervention was evaluated using Kaplan–Meier survival analysis, with group differences assessed by the log-rank test. Postoperative outcomes were assessed using standard statistical methods, with a significance level set at p < 0.05. Results: Between October 2010 and May 2025, a total of 292 patients underwent FET surgery at our center. Of these, 57 patients were identified as having HTAD and 235 as non-HTAD. Following propensity score matching, 50 patients remained in each group. The genetic aetiologies in the HTAD cohort were Marfan syndrome ( n = 39), Loeys–Dietz syndrome ( n = 11), and nonsyndromic forms ( n = 5). After matching, smoking status (non-HTAD n = 22 vs. HTAD n = 10, p = 0.021) and age (54.8 ± 9.3 years vs. 44.3 ± 10.5 years, p < 0.001) remained significantly different between groups. Despite these differences, HTAD patients showed no significant differences in outcomes in terms of 30-day mortality (2% vs. 6%, p = 0.617), ICU stay (5.5 ± 5.5 days vs. 6.5 ± 9.4 days, p = 0.541) permanent stroke ( n = 4 vs. n = 3, p = 1), renal failure ( n = 5 vs. n = 5), p = 1), and stent complications ( n = 4 vs. n = 1, p = 0.362). The mean follow-up was 2 years. A Kaplan–Meier analysis showed no statistically significant difference in the freedom from re-operation or re-intervention between the two cohorts ( p = 0.66), with cumulative freedom rates of 60% vs. 66% at 12, and 58% vs. 61% at 24 months for the non-HTAD and HTAD groups, respectively. Conclusion: Early outcomes after FET surgery were comparable between HTAD and non-HTAD patients. Reinterventions, as a potential indicator of distal stent-related complications, likewise did not differ in the early phase. However, subgroup sizes were too small to allow reliable conclusions regarding individual HTAD syndromes and their genetic variants. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany