Background: The frozen elephant trunk (FET) technique has revolutionized the surgical management of aortic dissection. However, distal stent-graft-induced new entry (dSINE) and reinterventions remain major challenges. This study presents the long-term results of a dissection-specific (DS) “Soft Elephant Trunk” (SET) (MedEng, Penza, Russia) hybrid prosthesis and its impact on distal remodeling compared to conventional hybrid prosthesis.
Methods: A retrospective review of hybrid aortic repairs from 2014 to 2024 identified 241 patients with aortic dissection. Patients were categorized into two cohorts: DS SET prosthesis (n=170) and conventional prosthesis (non-DS, n=71). Propensity score matching was performed. Primary endpoints included the incidence of dSINE and aortic reinterventions. Secondary endpoints evaluated perioperative complications and long-term survival. Cox regression analysis identified independent predictors of dSINE.
Results: Survival rates, freedom from reoperation, and the incidence of dSINE did not differ between the groups. However, cumulative incidence of new events—including distal aortic reoperations and dSINE—was significantly lower in the DS group versus non-DS both before matching (12.9% vs. 29.6%, P<0.001) and after matching (15.5% vs. 29.6%, P=0.04). Long-term endoleak rates (>5 years) were significantly higher in the non-DS group (31.4% vs. 7.1%, P=0.009). According to multivariable Cox regression analysis, the key predictors for dSINE included connective tissue disease [hazard ratio (HR) =3.22, 95% confidence interval (CI): 1.09–9.52, P=0.034], Stanford type B aortic dissection (HR =4.3, 95% CI: 7–14.61, P=0.019), and chronic phase of dissection (HR =7.8, 95% CI: 0.72–84.21, P=0.09). The highest dSINE risk was observed in non-DS patients with chronic dissection (P=0.009), Type B dissection (P=0.012), CTD (P=0.005), and aortic dilation >45 mm (P=0.004).
Conclusions: In comparison to conventional hybrid grafts, the SET graft exhibits a protective trend against dSINE, particularly in high-risk cases. This strategy may reduce distal complications and the need for secondary interventions, thereby improving long-term patient outcomes.