title: Aortic remodelling in aortic dissection after frozen elephant trunk†.
abstract: OBJECTIVE
  Frozen elephant trunk (FET) can be used for continuous downstream aorta treatment in acute aortic dissection (AAD) and chronic aortic dissection (CAD). The study reports the changes in the lumen volumes along the downstream aorta towards remodelling.
  
  
  METHODS
  In 70 patients (22 CAD, 48 AAD), pre-, postoperative and at least the 1-year follow-up aortic imaging was available. Volume changes of aortic lumen (AL) and true lumen (TL) between examinations along the stent graft aortic segment (A), downstream to coeliac trunk (B) and distally to bifurcation (C) were used for quantification. TL increase >10% with stable AL or AL decrease >10% with stable TL were classified as positive, changes within a 10% threshold as stable, and all other changes as negative remodelling.
  
  
  RESULTS
  In AAD, positive or stable remodelling occurred in A (90%), B (65%), C (58%) within 1 year, thereafter in 26 patients (follow-up: 47 ± 21 months) in A (92%), B (65%), C (62%). Negative remodelling in ≥2 segments was found in 5/26 (19%) patients. In CAD, positive or stable remodelling occurred in A (100%), B (86%), C (77%) within 1 year, thereafter in 16 patients (follow-up: 46 ± 20 months) in A (75%), B (44%), C (38%). Negative remodelling in ≥2 segments was found in 7/16 (43%) patients, 5 underwent reintervention, and stabilized thereafter.
  
  
  CONCLUSIONS
  FET facilitates positive remodelling in AAD and CAD down to stent graft level. Distally, 20% AAD and 40% CAD patients remain at risk for secondary reintervention, and can be identified by negative remodelling in ≥2 segments in the follow-up examinations.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, Essen, Germany ds.dohle@uk-essen.de.
authors.forename: Daniel-Sebastian
authors.initials: DS
authors.lastname: Dohle
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.affiliation: Department of Cardiology, West German Heart Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Rolf Alexander
authors.initials: RA
authors.lastname: Janosi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Benedik
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Hilmar
authors.initials: H
authors.lastname: Kühl
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Liuba
authors.initials: L
authors.lastname: Penkova
authors.affiliation: Department of Research on Learning and Instruction, Institute of Educational Science, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Stebner
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aortic dissection; Aortic remodelling; Frozen elephant trunk