Clinical Outcomes of Contemporary Frozen Elephant Trunk Prostheses and the Ascyrus Medical Dissection Stent in Aortic Arch Surgery: A Systematic Review and Proportional Meta-Analysis.
9 affiliations
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK.
- 2Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
- 3Department of General Surgery, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, UK.
- 4Royal Devon and Exeter Hospital, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
- 5Aston Medical School, Aston University, Birmingham, UK.
- 6Lancaster Medical School, University of Lancaster, Lancaster, UK.
- 7Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, TN, India.
- 8Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.
- 9Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK.
Abstract
Introduction
The frozen elephant trunk (FET) technique is an established strategy for complex aortic arch and descending thoracic aortic pathology. Several covered FET prostheses are available, while the Ascyrus Medical Dissection Stent (AMDS) represents a distinct uncovered hybrid arch adjunct used principally during open repair of acute type A dissection. This systematic review evaluated the reported clinical and aortic outcomes of contemporary FET prostheses and the AMDS.Methods
MEDLINE, Embase, Scopus and Web of Science were searched from inception to January 2025 in accordance with PRISMA 2020 and the Cochrane Handbook. Random-effects proportional meta-analysis and exploratory study-level meta-regression were undertaken for Thoraflex, E-vita, Frozenix and Cronus, with the AMDS retained as a separate device stratum. Results were reported with 95% confidence intervals (CIs).Results
A total of 114 studies encompassing 13,051 patients were included. Pooled all-cause mortality over the reported follow-up was 13.2% (95% CI 11.2-15.7%), while combined 30-day/in-hospital mortality was 8.4% (95% CI 7.4-9.5%), ranging from 5.1% to 14.5% across device strata. Five-year survival was 80.0% (95% CI 75.6-83.8%). Permanent neurological deficit ranged from 4.0% to 8.8%, and spinal cord ischaemia or paraplegia ranged from 0% to 7.0%. The pooled reintervention rate was 12.7% (95% CI 10.6-15.2%). Distal stent-induced new entry ranged from 0% to 8.9%, and endoleak ranged from 3.2% to 7.5%. Both clinical and statistical heterogeneity was substantial for several outcomes, and the device strata differed materially in pathology, urgency, age, operative strategy, and follow-up.Conclusion
Contemporary FET prostheses and the AMDS were associated with broadly acceptable reported outcomes within their respective clinical settings. However, the predominantly observational evidence, heterogeneous case mix and differing device indications preclude definitive conclusions regarding comparative superiority. The pooled values should be used as descriptive benchmarks. Device selection should therefore be individualised according to aortic pathology, anatomy, operative urgency and institutional expertise. Prospective comparative studies using standardised outcome definitions and appropriate risk adjustment are required.
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BibTeX
@article{jubouri2026clinical,
title = {{Clinical Outcomes of Contemporary Frozen Elephant Trunk Prostheses and the Ascyrus Medical Dissection Stent in Aortic Arch Surgery: A Systematic Review and Proportional Meta-Analysis.}},
author = {Matti Jubouri and Abdelaziz O Surkhi and Rohan Chikhal and Rami S N Alaraj and Aya Hammad and Yousif F Jubouri and Marco David Bokobza De la Rosa and Noor Halaseh and Idhrees Mohammed and Damian M Bailey and Ian M Williams and Mohamad Bashir},
journal = {Medical devices (Auckland, N.Z.)},
year = {2026},
month = oct,
doi = {10.2147/mder.s609165},
url = {https://europepmc.org/article/MED/42936324},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Clinical Outcomes of Contemporary Frozen Elephant Trunk Prostheses and the Ascyrus Medical Dissection Stent in Aortic Arch Surgery: A Systematic Review and Proportional Meta-Analysis.
AU - Matti Jubouri
AU - Abdelaziz O Surkhi
AU - Rohan Chikhal
AU - Rami S N Alaraj
AU - Aya Hammad
AU - Yousif F Jubouri
AU - Marco David Bokobza De la Rosa
AU - Noor Halaseh
AU - Idhrees Mohammed
AU - Damian M Bailey
AU - Ian M Williams
AU - Mohamad Bashir
PY - 2026
DA - 2026/10/22
JO - Medical devices (Auckland, N.Z.)
DO - 10.2147/mder.s609165
UR - https://europepmc.org/article/MED/42936324
AB - Introduction The frozen elephant trunk (FET) technique is an established strategy for complex aortic arch and descending thoracic aortic pathology. Several covered FET prostheses are available, while the Ascyrus Medical Dissection Stent (AMDS) represents a distinct uncovered hybrid arch adjunct used principally during open repair of acute type A dissection. This systematic review evaluated the reported clinical and aortic outcomes of contemporary FET prostheses and the AMDS.Methods MEDLINE, Embase, Scopus and Web of Science were searched from inception to January 2025 in accordance with PRISMA 2020 and the Cochrane Handbook. Random-effects proportional meta-analysis and exploratory study-level meta-regression were undertaken for Thoraflex, E-vita, Frozenix and Cronus, with the AMDS retained as a separate device stratum. Results were reported with 95% confidence intervals (CIs).Results A total of 114 studies encompassing 13,051 patients were included. Pooled all-cause mortality over the reported follow-up was 13.2% (95% CI 11.2-15.7%), while combined 30-day/in-hospital mortality was 8.4% (95% CI 7.4-9.5%), ranging from 5.1% to 14.5% across device strata. Five-year survival was 80.0% (95% CI 75.6-83.8%). Permanent neurological deficit ranged from 4.0% to 8.8%, and spinal cord ischaemia or paraplegia ranged from 0% to 7.0%. The pooled reintervention rate was 12.7% (95% CI 10.6-15.2%). Distal stent-induced new entry ranged from 0% to 8.9%, and endoleak ranged from 3.2% to 7.5%. Both clinical and statistical heterogeneity was substantial for several outcomes, and the device strata differed materially in pathology, urgency, age, operative strategy, and follow-up.Conclusion Contemporary FET prostheses and the AMDS were associated with broadly acceptable reported outcomes within their respective clinical settings. However, the predominantly observational evidence, heterogeneous case mix and differing device indications preclude definitive conclusions regarding comparative superiority. The pooled values should be used as descriptive benchmarks. Device selection should therefore be individualised according to aortic pathology, anatomy, operative urgency and institutional expertise. Prospective comparative studies using standardised outcome definitions and appropriate risk adjustment are required.
SN - 1179-1470
ER -