Long-term results of the frozen elephant trunk procedure: 10-year experience of a single center

Background. The frozen elephant trunk (FET) procedure is a widely used method for treating extensive thoracic aortic diseases. Despite its significant advantages, a high risk of distal aortic complications requiring reintervention remains. Objectives. To evaluate outcomes of the FET procedure, the frequency and nature of reinterventions, and risk factors associated with reoperations. Materials and methods. We performed a retrospective single-center observational study of 347 patients who underwent FET from 2014 to 2025. Various hybrid prostheses were used, including the Russian dissection-specific stent-graft “Soft Elephant Trunk.” Survival and risk factor analyses were performed using Kaplan–Meier and multivariate logistic regression. Results. The mean patient age was 52,8±11,5 years, with 71 % male. Ten-year survival was 78 %. Reinterventions were required in 13,5 % of patients, including 11,2 % distal and 1,7 % proximal reinterventions. The main cause of unplanned reinterventions (n=19, 5,5 %) was negative remodeling, which in 58 % of cases of new distal stent graft-induced new entry (dSINE), whereas staged reinterventions were performed in 20 cases (5,7 %). Open surgical reinterventions were associated with higher 7-year survival (90 %) compared to endovascular treatments (60 %). Connective tissue disorder was an independent predictor of reintervention risk (HR 4,11, p=0,002). Conclusions. The FET procedure remains the gold standard for treating extensive thoracic aortic disease, ensuring high long-term survival. Our study showed that open surgery after FET provides better long-term results compared to endovascular interventions. Connective tissue disorders require dynamic CT follow-up. Optimization of surgical strategy, and active postoperative monitoring remain key factors in successful treatment and prevention of complications.