{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:28Z","timestamp":1792785868136,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"High-Risk Cardiovascular Research Fund"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["HL088955"],"award-info":[{"award-number":["HL088955"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p\/>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>A better surgical approach for acute DeBakey type I dissection has been sought for decades. We compare operative trends, complications, reinterventions and survival after limited versus extended-classic versus modified frozen elephant trunk (mFET) repair for this condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>From 1 January 1978 to 1 January 2018, 879 patients underwent surgery for acute DeBakey type I dissection at Cleveland Clinic. Repairs were limited to the ascending aorta\/hemiarch (701.79%) or extended through the arch [extended classic (88.10%) or mFET (90.10%)]. Weighted propensity score matched established comparable groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among weighted propensity-matched patients, mFET repair had similar circulatory arrest times and postoperative complications to limited repair, except for postoperative renal failure, which was twice as high in the limited group [25% (n\u2009=\u200919) vs 12% (n\u2009=\u20099), P\u2009=\u20090.006]. Lower in-hospital mortality was observed following limited compared to extended-classic repair [9.1% (n\u2009=\u20097) vs 19% (n\u2009=\u200916), P\u2009=\u20090.03], but not after mFET repair [12% (n\u2009=\u20099) vs 9.5% (n\u2009=\u20098), P\u2009=\u20090.6]. Extended-classic repair had higher risk of early death than limited repair (P\u2009=\u20090.0005) with no difference between limited and mFET repair groups (P\u2009=\u20090.9); 7-year survival following mFET repair was 89% compared to 65% after limited repair. Most reinterventions following limited or extended-classic repair underwent open reintervention. All reinterventions following mFET repair were completed endovascularly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Without increasing in-hospital mortality or complications, less renal failure and a trend towards improved intermediate survival, mFET may be superior to limited or extended-classic repair for acute DeBakey type I dissections. mFET repair facilitates endovascular reintervention, potentially reducing future invasive reoperations and warranting continued study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezad122","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T13:04:45Z","timestamp":1680699885000},"source":"Crossref","is-referenced-by-count":16,"title":["The modified frozen elephant trunk may outperform limited and extended-classic repair in acute type I dissection"],"prefix":"10.1093","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-7987","authenticated-orcid":false,"given":"Eric E","family":"Roselli","sequence":"first","affiliation":[{"name":"Aorta Center, Heart Vascular and Thoracic Institute, Cleveland Clinic , Cleveland, OH, USA"},{"name":"Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic , Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic , Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emidio","family":"Germano","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic , Cleveland, OH, 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