{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T12:36:18Z","timestamp":1793795778646,"version":"4.6.1"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>For surgical repair of acute type I aortic dissection, total arch replacement (TAR) with a frozen elephant trunk (FET) has been known to result in better long-term remodelling of a residual false lumen. This study was designed to investigate the impact of the elephant trunk by comparing long-term remodelling features among different extents and strategies of aortic replacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-centre retrospective analysis of patients who underwent surgical repair for acute type I aortic dissection from January 2004 to June 2022. Patients were categorized based on the surgical strategy employed: non-TAR, conventional TAR, TAR with a classic elephant trunk (CET) and TAR-FET. The primary outcomes were positive remodelling of the residual false lumen and composite aortic events, with secondary outcomes focusing on early postoperative results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 327 patients were included. TAR, when combined with the insertion of an ET, whether it was stented or not, significantly promoted favourable aortic remodelling (P\u2009&amp;lt;\u2009.001). Compared with TAR-CET, the FET group tended towards faster false lumen thrombosis and regression, albeit without a significant difference in ultimate remodelling rates; 1-year and 5-year rates of proximal descending false lumen thrombosis were 85.4% (95% confidence interval [CI], 69.2-100) and 90.3% (95% CI, 75.9-100), respectively, after TAR-FET; additionally, these aforementioned rates were 65.7% (95% CI, 54.7-76.6) and 81.9% (95% CI, 71.8-91.9), respectively, after TAR-CET. No significant differences were observed in early postoperative outcomes or overall survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The favourable remodelling of the residual false lumen after TAR-FET shown in this study is in line with results from previous studies. CET might be a reasonable alternative to FET according to the individual patient risk profiles and institutional logistics situation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivag023","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T12:20:58Z","timestamp":1768825258000},"source":"Crossref","is-referenced-by-count":1,"title":["Impact of the Elephant Trunk on Distal Remodelling After Surgery for Acute Type I Aortic Dissection"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8306-7627","authenticated-orcid":false,"given":"You Kyeong","family":"Park","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine , Bucheon,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5516-0333","authenticated-orcid":false,"given":"Hyoung Woo","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1111-9627","authenticated-orcid":false,"given":"Kay-Hyun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4555-5782","authenticated-orcid":false,"given":"Joon Chul","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4769-5340","authenticated-orcid":false,"given":"Jae Hang","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4285-8200","authenticated-orcid":false,"given":"Jun Sung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"2026021107564855000_ivag023-B1","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1093\/ejcts\/ezv356","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)","volume":"49","author":"Conzelmann","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026021107564855000_ivag023-B2","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.jtcvs.2020.09.147","article-title":"Current status of open surgery for acute type A aortic dissection in Japan","volume":"164","author":"Okita","year":"2022","journal-title":"J Thorac Cardiovasc 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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 Surg"},{"key":"2026021107564855000_ivag023-B15","doi-asserted-by":"crossref","first-page":"S81","DOI":"10.1016\/j.jtcvs.2010.07.039","article-title":"Complex thoracic aortic disease: single-stage procedure with the frozen elephant trunk technique","volume":"140","author":"Di Bartolomeo","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026021107564855000_ivag023-B16","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.xjon.2023.05.014","article-title":"False lumen-dependent segmental arteries are associated with spinal cord injury in frozen elephant trunk procedure for acute type I aortic dissection","volume":"15","author":"Dong","year":"2023","journal-title":"JTCVS 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