Outcomes of Patients with Subacute/Chronic DeBakey Type I Aortic Dissection: A Multicenter Study

ABSTRACT BACKGROUND The optimal surgical strategy for subacute and chronic DeBakey type I aortic dissection remains controversial. This multicenter study compared early outcomes and long-term survival between total arch replacement (TAR) with a frozen elephant trunk (FET) and conventional non-FET repair. METHODS We retrospectively analyzed 452 patients who underwent surgery for subacute or chronic DeBakey type I aortic dissection at seven high-volume aortic centers between 2015 and 2023. Of these, 320 patients received TAR+FET and 132 underwent non-FET procedures. Perioperative outcomes and long-term survival were assessed using inverse probability of treatment weighting (IPTW), Kaplan–Meier survival curves, and landmark analysis. RESULTS After IPTW adjustment, thirty-day mortality was higher in the FET group than in the non-FET group (6.2% vs. 2.0%, P=0.044). However, there was no significant difference in overall survival between the two groups (log-rank P = 0.469). The landmark analysis showed no difference in all-cause mortality within the first six years, but mortality was significantly lower in the FET group thereafter (1.8% vs. 12.5%, P=0.007). CONCLUSIONS In patients with subacute or chronic DeBakey type I dissection, TAR+FET is a feasible surgical method associated with increased early mortality, but potential late survival benefit compared with non-FET approaches. These findings warrant confirmation in prospective studies with extended follow-up.