{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:23:27Z","timestamp":1784888607975,"version":"3.55.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>To analyse risk factors for early mortality and long-term survival including secondary distal aortic interventions in patients undergoing frozen elephant trunk surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A retrospective single-centre study was conducted, including all 222 patients who underwent frozen elephant trunk surgery between 2010 and 2022. We used multivariable regression analysis to detect risk factors for early mortality and Kaplan\u2013Meier analysis for long-term survival and secondary interventions. We introduce the term \u2018complicated acute type A dissection\u2019 for those patients in whom the dissection was complicated by malperfusion syndrome, aortic rupture, pre-hospital intubation or resuscitation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Thirty-day mortality decreased significantly from 18.9% using the conventional zone 3 technique to 7.4% using a simplified zone 2 technique (P\u2009=\u20090.014). The aortic pathology had a significant impact on 30-day mortality: 1.4% in chronic dissection, 6.7% in aortic aneurysm, 7.4% in noncomplicated acute type A aortic dissection and 42.5% in complicated acute type A aortic dissection (P\u2009&amp;lt;\u20090.001). We identified complicated acute type A aortic dissection [odds ratio 15.7, confidence interval (CI) 5.2\u201347.3, P\u2009&amp;lt;\u20090.001], severe aortic atherosclerosis (odds ratio 4.9, CI 1.6\u201315.3, P\u2009=\u20090.006) and impaired renal function (odds ratio 3.7, CI 1.1\u201312.4, P\u2009=\u20090.035) as independent predictors of early mortality. Among 30-day survivors, 5-year survival was 84.3%, with no differences between pathologies. Secondary distal aortic interventions (37.4%) did not affect 5-year survival (P\u2009=\u20090.909).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Early mortality after frozen elephant trunk surgery is strongly driven by preoperative patient condition, particularly in the presence of complicated acute type A dissection. Once the early postoperative phase is overcome, long-term outcome is favourable across pathologies, regardless of secondary interventions. Careful patient selection and regular follow-up are crucial for optimizing outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf213","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T09:35:23Z","timestamp":1751016923000},"source":"Crossref","is-referenced-by-count":3,"title":["Complicated acute type A aortic dissection and severe aortic atherosclerosis predict early mortality after frozen elephant trunk procedure"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2180-4350","authenticated-orcid":false,"given":"Christian","family":"Detter","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8990-2363","authenticated-orcid":false,"given":"Lennart","family":"Bax","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8477-661X","authenticated-orcid":false,"given":"Giuseppe","family":"Panuccio","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9962-0204","authenticated-orcid":false,"given":"Tilo","family":"K\u00f6lbel","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yskert","family":"von Kodolitsch","sequence":"additional","affiliation":[{"name":"Clinic for Thoracic and Cardiovascular Surgery, Section of Vascular Surgery, Heart and Diabetes Centre North Rhine Westphalia , Bad Gehlhausen,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Reichenspurner","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8978-9914","authenticated-orcid":false,"given":"Till Joscha","family":"Demal","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Brickwedel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"2025072618315248000_ezaf213-B1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezad426","article-title":"EACTS\/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","author":"Czerny","year":"2024"},{"key":"2025072618315248000_ezaf213-B2","first-page":"738","article-title":"Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases","author":"Detter","year":"2019"},{"key":"2025072618315248000_ezaf213-B3","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.athoracsur.2019.01.004","article-title":"Neurologic deficit after aortic arch replacement: the influence of the aortic atherosclerosis","volume":"108","author":"Tokuda","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"2025072618315248000_ezaf213-B4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on clinical practice guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"2025072618315248000_ezaf213-B5","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/s12874-017-0436-z","article-title":"New methods for estimating follow-up rates in cohort studies","volume":"17","author":"Xue","year":"2017","journal-title":"BMC Med Res Methodol"},{"key":"2025072618315248000_ezaf213-B6","first-page":"458","article-title":"The frozen elephant trunk technique in an emergency: THORAFLEX French National Registry offers new insights","author":"Chabry","year":"2021"},{"key":"2025072618315248000_ezaf213-B7","doi-asserted-by":"crossref","first-page":"178","DOI":"10.21037\/acs-2020-fet-25","article-title":"Results of frozen elephant trunk from the international E-vita Open registry","volume":"9","author":"Tsagakis","year":"2020","journal-title":"Ann Cardiothorac Surg"},{"key":"2025072618315248000_ezaf213-B8","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1093\/ejcts\/ezz037","article-title":"Multicentre experience with two frozen elephant trunk prostheses in the treatment of acute aortic dissection\u2020","volume":"56","author":"Berger","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025072618315248000_ezaf213-B9","first-page":"858","article-title":"Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years","author":"Shrestha","year":"2017"},{"key":"2025072618315248000_ezaf213-B10","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.ijcard.2018.05.111","article-title":"Acute type A aortic dissection: rationale and outcomes of extensive repair of the arch and distal aorta","volume":"267","author":"Di Marco","year":"2018","journal-title":"Int J Cardiol"},{"key":"2025072618315248000_ezaf213-B11","first-page":"1104","article-title":"Extended versus limited arch replacement in acute type A aortic dissection","author":"Larsen","year":"2017"},{"key":"2025072618315248000_ezaf213-B12","first-page":"e44\u201352","article-title":"Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA)","author":"Conzelmann","year":"2016"},{"key":"2025072618315248000_ezaf213-B13","doi-asserted-by":"crossref","first-page":"i29","DOI":"10.1093\/ejcts\/ezw341","article-title":"Total aortic arch replacement with the frozen elephant trunk procedure in acute DeBakey type I aortic dissections","volume":"51","author":"Shrestha","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025072618315248000_ezaf213-B14","first-page":"940","article-title":"Total aortic arch repair: risk factor analysis and follow-up in 199 patients","volume-title":"Eur J Cardiothorac Surg","author":"Martens","year":"2016"},{"key":"2025072618315248000_ezaf213-B15","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1093\/ejcts\/ezab063","article-title":"Is total aortic arch replacement with the frozen elephant trunk procedure reasonable in elderly patients?","volume":"60","author":"Beckmann","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025072618315248000_ezaf213-B16","doi-asserted-by":"crossref","first-page":"2628","DOI":"10.1016\/j.jacc.2015.04.030","article-title":"The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA registry","volume":"65","author":"Czerny","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2025072618315248000_ezaf213-B17","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jtcvs.2022.09.034","article-title":"Survival after operative repair of acute type A aortic dissection varies according to the presence and type of preoperative malperfusion","volume":"168","author":"Wolfe","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025072618315248000_ezaf213-B18","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.xjon.2022.03.001","article-title":"Surgical management and outcomes in patients with acute type A aortic dissection and cerebral malperfusion","volume":"10","author":"Vendramin","year":"2022","journal-title":"JTCVS Open"},{"key":"2025072618315248000_ezaf213-B19","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1093\/ejcts\/ezw387","article-title":"Acute type A dissection in octogenarians: does emergency surgery impact in-hospital outcome or long-term survival?","volume":"51","author":"Dumfarth","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025072618315248000_ezaf213-B20","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1161\/CIRCULATIONAHA.118.036328","article-title":"Endovascular fenestration\/stenting first followed by delayed open aortic repair for acute type A aortic dissection with malperfusion syndrome","volume":"138","author":"Yang","year":"2018","journal-title":"Circulation"},{"key":"2025072618315248000_ezaf213-B21","doi-asserted-by":"crossref","first-page":"e017939","DOI":"10.1161\/JAHA.120.017939","article-title":"Effect of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest in aortic arch surgery on postoperative renal function: a systematic review and meta-analysis","volume":"9","author":"Cao","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025072618315248000_ezaf213-B22","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1093\/icvts\/ivz220","article-title":"Lower body ischaemic time is a risk factor for acute kidney injury after surgery for type A acute aortic dissection","volume":"30","author":"Amano","year":"2020","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025072618315248000_ezaf213-B23","doi-asserted-by":"crossref","first-page":"e463\u20135","DOI":"10.1016\/j.athoracsur.2017.08.004","article-title":"Aortic arch hybrid repair: stent-bridging of the supra-aortic vessel anastomoses (SAVSTEB)","volume":"104","author":"Pichlmaier","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2025072618315248000_ezaf213-B24","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.athoracsur.2017.08.037","article-title":"Evolution of simplified frozen elephant trunk repair for acute DeBakey type I dissection: midterm outcomes","volume":"105","author":"Roselli","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2025072618315248000_ezaf213-B25","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1177\/15385744211002493","article-title":"\u201cProximalization is advancement\u201d\u2014zone 3 frozen elephant trunk vs zone 2 frozen elephant trunk: a literature review","volume":"55","author":"Choudhury","year":"2021","journal-title":"Vasc Endovascular Surg"},{"key":"2025072618315248000_ezaf213-B26","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/icvts\/ivab059","article-title":"Outcome of the frozen elephant trunk procedure as a redo operation","volume":"33","author":"Demal","year":"2021","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025072618315248000_ezaf213-B27","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/SLA.0000000000006271","article-title":"A retrospective analysis of 10-year experience on branched and fenestrated endovascular aortic arch repair","volume":"282","author":"Rohlffs","year":"2025","journal-title":"Ann Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezaf213\/63606921\/ezaf213.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/7\/ezaf213\/63606921\/ezaf213.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/7\/ezaf213\/63606921\/ezaf213.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T22:31:59Z","timestamp":1753569119000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezaf213\/8176616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":27,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaf213","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2025,6,27]]},"article-number":"ezaf213"}}