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Personalizing frozen elephant trunk repair in acute type A aortic dissection: mid-term outcomes of conventional Cronus™, Fontus™, and Modified Cronus™
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DOI：10.1186/s40001-026-05026-z.png)
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Abstract
En 中文
Optimal choice among frozen elephant trunk (FET) stents for total arch reconstruction (TAR) in acute Type A aortic dissection (TAAD) remains debated. This study compares clinical outcomes of three FET stents: conventional Cronus™ (C–C), Fontus™ (F–S), and modified Cronus™ (M–C). Single-center retrospective analysis of 520 consecutive TAAD patients (2018–2025) undergoing TAR with FET stents (C–C:160, F–S:188, M–C:172). Perioperative and mid-term outcomes were compared using multivariable regression. E‑values were calculated to assess robustness to unmeasured confounding. Operative times were shortest with M–C, followed by F–S and C–C (all P < 0.001). Thirty-day mortality was similar among groups, with an overall rate of 4.8% (25/520). Stroke incidence was lower with F–S (5.3%) and M–C (5.8%) than C–C (13.1%; P = 0.019). C–C stent and CPB time independently predicted stroke. Recurrent laryngeal nerve palsy (8.1%) and chylothorax (4.4%) occurred only with C–C. Six M–C patients (3.5%) developed type Ia endoleak; all occurred within the first 20 cases (30.0%) with no further endoleaks in the subsequent 152 cases after suture reinforcement. F–S incurred highest costs (P = 0.021). At median 46-month follow-up, 5-year survival (86.2–89.1%) and reintervention rates (7.7%) were comparable. E‑value analysis (≥ 5.2) supported robustness of stroke findings. The non-randomized, anatomy-driven allocation may introduce selection bias, and the observed differences may partially reflect baseline anatomical complexity rather than device-specific effects alone. The C–C stent, while universally applicable, carries higher operative morbidity and stroke risk. The F–S stent simplifies arch repair with excellent neurologic outcomes at increased cost. The M–C stent offers superior operative efficiency and hemostasis with a mitigable endoleak risk. Based on these findings, we propose a hypothesis-generating stepwise algorithm that warrants prospective validation, prioritizing Fontus™ for suitable LSA anatomy, M–C with suture reinforcement for favorable arch anatomy, and C–C as the universal default for complex cases.
Keywords:
Aortic dissection
Vascular surgical procedures
Blood vessel prosthesis
Stents
Treatment outcome
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