{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:51:03Z","timestamp":1789469463501,"version":"build-2803163510"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T00:00:00Z","timestamp":1628640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>\u2002<\/jats:title>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>To improve organ protection with the frozen elephant trunk (FET) procedure, a so-called four-sites perfusion in combination with proximalization for the distal aortic anastomosis was performed. The impact of these techniques on patient outcome is reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Between February 2005 and April 2020, a total of 357 patients underwent the FET procedure for acute (54%) or chronic (22%) aortic dissection or aneurysmal disease (24%). The level of the distal FET anastomosis was defined according to aortic arch zones 0\u20133. Patients were divided into 3 groups according to the intraoperative perfusion strategy: (i) selective antegrade cerebral perfusion (SACP) alone (N\u2009=\u200996, 2 sites); (ii) SACP plus left subclavian artery or distal aorta (N\u2009=\u200984, 3 sites) and (iii) SACP plus left subclavian artery plus distal aorta (N\u2009=\u2009177, 4 sites). Early outcome was addressed by a composite end point: occurrence of either a disabling stroke, a disabling spinal cord injury, extracorporeal circulatory support, kidney dialysis or death within 90\u2009days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Preoperative characteristics were similar among the groups. Surgery in group C was characterized by FET proximalization in arch zone \u22642, moderate hypothermia at 28\u00b0C and shorter periods of extracorporeal circulation, SACP, hypothermic circulatory arrest and cardioplegic arrest (P\u2009&amp;lt;\u20090.001, respectively). Occurrence of the composite end point was reduced in group C (P\u2009=\u20090.008). The combination of FET proximalization and four-sites perfusion was a protective factor for the composite outcome in multivariable analysis (P\u2009=\u20090.009). The 5-year survival was improved in patients who underwent FET proximalization in zone \u22642 (hazard ratio 0.7, 95% confidence interval 0.4\u20131.0; P\u2009=\u20090.036).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>FET proximalization in combination with four-sites perfusion has the potential to improve patient outcomes in terms of survival and major events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subject collection<\/jats:title>\n                    <jats:p>120; 161.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezab295","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T07:13:17Z","timestamp":1627974797000},"page":"195-203","source":"Crossref","is-referenced-by-count":30,"title":["The frozen elephant trunk technique: impact of proximalization and the four-sites perfusion technique"],"prefix":"10.1093","volume":"61","author":[{"given":"Konstantinos","family":"Tsagakis","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Osswald","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Weymann","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aydin","family":"Demircioglu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian","family":"Schmack","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Wendt","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz","family":"Jakob","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjang","family":"Ruhparwar","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,11]]},"reference":[{"key":"2021122915024829900_ezab295-B1","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1093\/ejcts\/ezv150","article-title":"Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: results of a multicentre study","volume":"49","author":"Leontyev","year":"2016","journal-title":"Eur J Cardiothorac 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