{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:29Z","timestamp":1787721629934,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,7,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The impact of intimal tear location on outcomes in acute Stanford type A aortic dissection remains unclear. This study investigated the impact of different tear locations on early and long\u2010term death in patients undergoing total arch replacement with frozen elephant trunk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">This single\u2010center retrospective study included 1524 patients with acute Stanford type A aortic dissection who underwent total arch replacement with frozen elephant trunk from January 2010 to December 2022. Patients were stratified by primary entry tear location: ascending aorta (n=857 [56.2%]), aortic arch (n=459 [30.1%]), and descending aorta (n=208 [13.6%]). Primary end points were in\u2010hospital death and long\u2010term survival. Multivariable regression analyses with further sensitivity analyses for early and long\u2010term outcomes were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In\u2010hospital death differed significantly among groups (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.035): descending tear (21 [10.1%]) versus ascending (46 [5.4%]) versus arch (24 [5.2%]). Multivariable analysis identified descending tear as an independent predictor of in\u2010hospital death (odds ratio, 3.728 [95% CI, 1.934\u20137.188];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). During a median follow\u2010up period of 48.2 months, descending tear location remained independently associated with increased long\u2010term mortality risk (hazard ratio [HR], 2.140 [95% CI, 1.418\u20133.230];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), while arch tears showed no significant difference from ascending tears (HR, 1.232;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.227). Reintervention rates did not differ among groups after multivariable adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Intimal tear location significantly impacts acute Stanford type A aortic dissection prognosis. Descending aortic tears confer substantially higher early and long\u2010term mortality rates, requiring aggressive perioperative management and closer surveillance. Tear location should be incorporated into risk stratification systems for individualized treatment planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.048870","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:22:47Z","timestamp":1783074167000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Intimal Tear Location on Clinical Outcomes in Extensive Arch Repair of Acute Stanford Type A Aortic Dissection"],"prefix":"10.1161","volume":"15","author":[{"given":"Yumeng","family":"Ji","sequence":"first","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]},{"name":"Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung and Blood Vessel Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3297-5879","authenticated-orcid":false,"given":"Chenyu","family":"Zhou","sequence":"additional","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6818-377X","authenticated-orcid":false,"given":"Kai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung and Blood Vessel Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Gao","sequence":"additional","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Hou","sequence":"additional","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji","family":"Wang","sequence":"additional","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiqi","family":"Gao","sequence":"additional","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Xu","sequence":"additional","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3975-2408","authenticated-orcid":false,"given":"Xiaogang","family":"Sun","sequence":"additional","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7874-9052","authenticated-orcid":false,"given":"Cuntao","family":"Yu","sequence":"additional","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]},{"name":"Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung and Blood Vessel Diseases","place":["Beijing, China"]},{"name":"The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]},{"name":"The Second Affiliated Hospital, Zhejiang University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8162-6802","authenticated-orcid":false,"given":"Juntao","family":"Qiu","sequence":"additional","affiliation":[{"name":"National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(22)01970-5"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.05.029"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.117.031264"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezv356"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2024.11.025"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.11.7327"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1649511"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezae294"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12938-016-0258-y"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2023.04.023"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.01.020"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-98581-0"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezac040"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd10040147"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.07.061"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.21037\/acs.2016.06.01"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezad350"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf138"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.12.046"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.10.139"}],"container-title":["Journal 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