{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:48:56Z","timestamp":1793299736785,"version":"4.5.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T00:00:00Z","timestamp":1554076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>We compared the results of 2 groups of patients who underwent aortic arch replacement with the frozen elephant trunk technique. In the first group, the distal anastomosis was performed in arch zone 2; in the second control group, the distal anastomosis was performed in arch zone 3.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Between January 2007 and April 2018, the frozen elephant trunk technique was used in 282 patients. The median age was 62\u2009years (range 18\u201383\u2009years), and 233 patients were men (82.6%). Two different frozen elephant trunk prostheses were used: the Jotec E-vita open prosthesis in 167 patients (59.2%) and the Vascutek Thoraflex hybrid prosthesis in 115 patients (40.8%). Patients were divided into 2 groups according to the distal anastomosis site: zone 2 group (69 patients) and zone 3 group (213 patients). The main indications were chronic aortic dissection (n\u2009=\u2009164, 58.2%), degenerative aneurysm (n\u2009=\u200972, 25.5%) and acute aortic dissections (n\u2009=\u200945, 16%).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The overall in-hospital mortality rate was 17%: 20% for the zone 2 group and 16% for the zone 3 group, without significant differences, also in terms of cardiopulmonary bypass and myocardial ischaemia times. However, the visceral ischaemia time was significantly shorter for the zone 2 group, whereas the antegrade selective cerebral perfusion time was significantly longer for the same group. Recurrent laryngeal nerve injury rate was lower in the zone 2 group. The overall postoperative paraplegia rate was 3.5%, whereas the occurrence of permanent neurological dysfunction and dialysis was 9% and 19%, respectively, with no significant differences between the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>\u2018Proximalization\u2019 of the distal anastomosis can be used for arch reconstruction, especially in complex cases such as reoperations or acute aortic dissections. Furthermore, with the aid of branched hybrid grafts, a reduction of the visceral ischaemia time is achieved.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezz103","type":"journal-article","created":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T12:08:17Z","timestamp":1553515697000},"page":"564-571","source":"Crossref","is-referenced-by-count":54,"title":["Open distal anastomosis in the frozen elephant trunk technique: initial experiences and preliminary results of arch zone 2 versus arch zone 3\u2020"],"prefix":"10.1093","volume":"56","author":[{"given":"Alessandro","family":"Leone","sequence":"first","affiliation":[{"name":"Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Di Marco","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuditta","family":"Coppola","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Amodio","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Berardi","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S. 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Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Di Bartolomeo","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Pacini","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S. 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