{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:37:05Z","timestamp":1793317025225,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Mardigian Foundation"},{"name":"UM Faculty Group Practice; Terumo; and Ann and Bob Aikens"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Most ascending aortic replacements for acute type A aortic dissection (ATAAD) are performed utilizing hypothermic circulatory arrest with an \u201copen\u201d distal anastomosis (\u201chemiarch\u201d), whereas some are completed without ever removing the aortic cross-clamp. We sought to determine the impact of distal anastomotic technique in ascending aortic replacement for ATAAD repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All patients in the IRAD Interventional Cohort database who underwent ATAAD repair between 2010 and 2020 were identified (n\u2009=\u20092559). Data for distal anastomotic technique were available in 2031 patients who underwent ascending aortic replacement, divided into 2 groups, based on whether they underwent hypothermic circulatory arrest (Clamp Off, n\u2009=\u20091900 [93.5%]) or not (Clamp On, n\u2009=\u2009131, [6.5%]). We then propensity-matched 101 pairs of patients and analysed operative data and short- and mid-term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In-hospital mortality for the unmatched population was 13.1% (266 deaths), not statistically different between the matched groups (Clamp Off, 11.0% vs Clamp On, 5.1% P\u2009=\u2009.22). There were no statistically significant differences observed in 3-year post-discharge survival curves between matched cohorts (Clamp Off, 89.5% vs Clamp On, 90.4%; stratified log-rank P-value\u2009=\u2009.46). Major perioperative complications (renal failure requiring dialysis, reoperation for bleeding, respiratory insufficiency) were not significantly different between the groups, notably including stroke (Clamp Off, 10.2% vs Clamp On, 5.8%, P\u2009=\u2009.32).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this propensity-matched cohort, postoperative mortality, major morbidity, and mid-term survival were comparable between open distal anastomosis and clamp-on strategies in selected patients undergoing ascending aortic replacement for ATAAD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivag093","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:43:13Z","timestamp":1775043793000},"source":"Crossref","is-referenced-by-count":2,"title":["Clamp On vs Off Impact of Distal Anastomotic Technique During Ascending Aortic Replacement in Acute Type A Aortic Dissection: IRAD Insights"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5477-6136","authenticated-orcid":false,"given":"Stevan S","family":"Pupovac","sequence":"first","affiliation":[{"name":"Department of Cardiovascular & Thoracic Surgery, Northwell Health , Manhasset, NY, 11103,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar A","family":"Jarral","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular & Thoracic Surgery, Northwell Health , Manhasset, NY, 11103,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5996-3264","authenticated-orcid":false,"given":"Santi","family":"Trimarchi","sequence":"additional","affiliation":[{"name":"Department of Scienze Cliniche e di Comunita\/Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, University of Milan , Milan, 20122,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1737-4012","authenticated-orcid":false,"given":"Ibrahim","family":"Sultan","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University of Pittsburgh , Pittsburgh, PA, 15213,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Leshnower","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Emory University , Atlanta, GA, 30322,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4456-5674","authenticated-orcid":false,"given":"Nimesh D","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University of Pennsylvania School of Medicine , Philadelphia, PA, 19104,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thoralf M","family":"Sundt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Massachusetts General Hospital , Boston, MA, 02114,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puja","family":"Kachroo","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery, Washington University School of Medicine , St. Louis, MO, 63110,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing-Guo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Nanjing Medical University , Nanjing, 210029,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Wen","family":"Pai","sequence":"additional","affiliation":[{"name":"Frankel Cardiovascular Center, University of Michigan , Ann Arbor, MI, 48109,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas G","family":"Gleason","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery, Asheville Heart , Asheville, NC, 28801,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7639-2416","authenticated-orcid":false,"given":"Himanshu J","family":"Patel","sequence":"additional","affiliation":[{"name":"Frankel Cardiovascular Center, University of Michigan , Ann Arbor, MI, 48109,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim A","family":"Eagle","sequence":"additional","affiliation":[{"name":"Frankel Cardiovascular Center, University of Michigan , Ann Arbor, MI, 48109,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek R","family":"Brinster","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular & Thoracic Surgery, Northwell Health , Manhasset, NY, 11103,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"2026042201013606200_ivag093-B1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/jocs.13511","article-title":"Contemporary management and outcomes of acute type A aortic dissection: an analysis of the STS adult cardiac surgery database","volume":"33","author":"Lee","year":"2018","journal-title":"J Card Surg"},{"key":"2026042201013606200_ivag093-B2","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.1016\/j.jtcvs.2016.12.029","article-title":"Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program","volume":"153","author":"Parikh","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042201013606200_ivag093-B3","doi-asserted-by":"crossref","first-page":"4545","DOI":"10.1111\/jocs.17085","article-title":"Outcomes of acute type A aortic dissection during the COVID-19 pandemic: an analysis of the Society of Thoracic Surgeons Database","volume":"37","author":"Arnaoutakis","year":"2022","journal-title":"J Card Surg"},{"key":"2026042201013606200_ivag093-B4","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.athoracsur.2017.02.066","article-title":"Hypothermia and selective antegrade cerebral perfusion is safe for arch repair in type a dissection","volume":"104","author":"Keeling","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2026042201013606200_ivag093-B5","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1016\/j.athoracsur.2015.05.032","article-title":"Moderate versus deep hypothermia with unilateral selective antegrade cerebral perfusion for acute type a dissection","volume":"100","author":"Leshnower","year":"2015","journal-title":"Ann Thorac Surg"},{"key":"2026042201013606200_ivag093-B6","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.athoracsur.2007.10.017","article-title":"Antegrade cerebral perfusion for acute type A aortic dissection in 120 consecutive patients","volume":"85","author":"Bakhtiary","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2026042201013606200_ivag093-B7","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1016\/j.hlc.2022.07.021","article-title":"Deep vs. moderate hypothermia in acute type A aortic dissection: a propensity-matched analysis","volume":"31","author":"Pupovac","year":"2022","journal-title":"Heart Lung Circ"},{"key":"2026042201013606200_ivag093-B8","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1093\/ejcts\/ezw289","article-title":"Fifteen years of surgery for acute type A aortic dissection in moderate-to-mild systemic hypothermia","volume":"51","author":"Zierer","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026042201013606200_ivag093-B9","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1016\/j.athoracsur.2021.01.027","article-title":"Moderate versus deep hypothermia in type A acute aortic dissection repair: insights from the International Registry of Acute Aortic Dissection","volume":"112","author":"Pupovac","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"2026042201013606200_ivag093-B10","doi-asserted-by":"crossref","first-page":"2888","DOI":"10.1016\/j.jtcvs.2014.01.020","article-title":"Profound hypothermia compared with moderate hypothermia in repair of acute type A aortic dissection","volume":"148","author":"Algarni","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042201013606200_ivag093-B11","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s00380-017-1037-9","article-title":"Randomized controlled trial of moderate hypothermia versus deep hypothermia anesthesia on brain injury during Stanford A aortic dissection surgery","volume":"33","author":"Sun","year":"2018","journal-title":"Heart Vessels"},{"key":"2026042201013606200_ivag093-B12","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1111\/trf.17117","article-title":"Factor eight inhibiting bypass activity for refractory bleeding in acute type A aortic dissection repair: a propensity-matched analysis","volume":"62","author":"Pupovac","year":"2022","journal-title":"Transfusion"},{"key":"2026042201013606200_ivag093-B13","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.ejcts.2003.11.022","article-title":"Can the principles of evidence-based medicine be applied to the treatment of aortic dissections?","volume":"25","author":"Myrmel","year":"2004","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026042201013606200_ivag093-B14","first-page":"77","article-title":"EACTS\/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"22","author":"Czerny","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"2026042201013606200_ivag093-B15","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.jtcvs.2021.04.053","article-title":"2021 The American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection","volume":"162","author":"Malaisrie","year":"2021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042201013606200_ivag093-B16","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/j.jtcvs.2018.09.020","article-title":"Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection","volume":"157","author":"Geirsson","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042201013606200_ivag093-B17","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1093\/icvts\/ivw044","article-title":"Open and closed distal anastomosis for acute type A aortic dissection repair","volume":"22","author":"Malvindi","year":"2016","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2026042201013606200_ivag093-B18","doi-asserted-by":"crossref","first-page":"I218","DOI":"10.1161\/01.cir.0000032890.55215.27","article-title":"Does profound hypothermic circulatory arrest improve survival in patients with acute type A aortic dissection?","volume":"106","author":"Lai","year":"2002","journal-title":"Circulation"},{"key":"2026042201013606200_ivag093-B19","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1510\/icvts.2010.256131","article-title":"Does the technique of distal anastomosis influence clinical outcomes in acute type A aortic dissection?","volume":"12","author":"Stamou","year":"2011","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2026042201013606200_ivag093-B20","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/j.1540-8191.2006.00369.x","article-title":"Comparison of operative techniques in acute type A aortic dissection performing the distal anastomosis","volume":"22","author":"Danner","year":"2007","journal-title":"J Card Surg"},{"key":"2026042201013606200_ivag093-B21","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/S1010-7940(99)00036-6","article-title":"Different techniques of distal aortic repair in acute type A dissection: impact on late aortic morphology and reoperation","volume":"15","author":"Nguyen","year":"1999","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026042201013606200_ivag093-B22","first-page":"SP05","article-title":"Combining survival analysis results after multiple imputation of censored event times","author":"Moscovici","year":"2017","journal-title":"PharmaSug"},{"key":"2026042201013606200_ivag093-B23","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1016\/j.athoracsur.2005.04.004","article-title":"Long-term effectiveness of total arch replacement for type A aortic dissection","volume":"80","author":"Ochiai","year":"2005","journal-title":"Ann Thorac Surg"},{"key":"2026042201013606200_ivag093-B24","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.jtcvs.2020.02.087","article-title":"Results of ascending aortic and arch replacement for type A aortic dissection","volume":"162","author":"Uchida","year":"2021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042201013606200_ivag093-B25","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1016\/j.jtcvs.2023.08.037","article-title":"Volume-failure-to-rescue relationship in acute type A aortic dissections: an analysis of the Society of Thoracic Surgeons Database","volume":"168","author":"Diaz-Castrillon","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042201013606200_ivag093-B26","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/j.jtcvs.2023.04.012","article-title":"Hemiarch versus extended arch repair for acute type A dissection: results from a multicenter national registry","volume":"167","author":"Elbatarny","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042201013606200_ivag093-B27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.xjtc.2021.05.002","article-title":"Acute type A aortic dissection and the consequences of a patent false lumen","volume":"9","author":"White","year":"2021","journal-title":"JTCVS Tech"},{"key":"2026042201013606200_ivag093-B28","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/1538574413518611","article-title":"Type A acute aortic dissection: why does the false channel remain patent after surgery?","volume":"48","author":"Bing","year":"2014","journal-title":"Vasc Endovascular Surg"},{"key":"2026042201013606200_ivag093-B29","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1093\/ejcts\/ezx062","article-title":"Fate of the dissected aortic arch after ascending replacement in type A aortic dissection","volume":"51","author":"Rylski","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026042201013606200_ivag093-B30","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.ijcard.2018.01.028","article-title":"Should the distal tears of aortic dissection be treated? The risk of distal tears after proximal repair of aortic dissection","volume":"261","author":"Zhang","year":"2018","journal-title":"Int J Cardiol"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivag093\/67782470\/ivag093.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/4\/ivag093\/67782470\/ivag093.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/4\/ivag093\/67782470\/ivag093.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:01:49Z","timestamp":1776834109000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivag093\/8586355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivag093","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,4,1]]},"article-number":"ivag093"}}