{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:03:37Z","timestamp":1791403417876,"version":"4.3.3"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T00:00:00Z","timestamp":1632787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> The study objective was to evaluate the effect of en bloc arch reconstruction with frozen elephant trunk (FET) technique for acute type A aortic dissection.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> 41 patients with acute Stanford type A dissection underwent en bloc arch reconstruction combined with FET implantation between April 2018 and August 2020. The mean age of the patients was 46 \u00b1 13 years, and 9 patients were female. One patient had Marfan syndrome. Six patients had pericardial tamponade, 9 had pleural effusion, 5 had transient cerebral ischemic attack, and 3 had chronic kidney disease.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The hospital mortality rate was 9.8% (4 patients). 2 (4.9%) patients had stroke, 23 (56.1%) had acute kidney injury, and 5 (12.2%) had renal failure requiring hemodialysis. During follow-up, the rate of complete false lumen thrombosis was 91.6% (33\/36) around the FET, 69.4% (25\/36) at the diaphragmatic level, and 27.8% (10\/36) at the superior mesenteric artery level. The true lumen diameter at the same three levels of the descending aorta increased significantly while the false lumen diameter reduced at the two levels: pulmonary bifurcation and the diaphragm. The 1-, 2-and 3-year actuarial survival rates were 90.2% [95% confidence interval (CI), 81.2\u201399.2], 84.2% (95% CI, 70.1\u201398.3) and 70.2% (95% CI, 42.2\u201398), respectively.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> In patients with acute type A dissection, en bloc arch reconstruction with FET technique appeared to be feasible and effective with early clinical follow-up results. Future studies including a large sample size and long-term follow-up are required to evaluate the efficacy.<\/jats:p>","DOI":"10.3389\/fcvm.2021.727125","type":"journal-article","created":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T05:20:04Z","timestamp":1632806404000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["En Bloc Arch Reconstruction With the Frozen Elephant Trunk Technique for Acute Type a Aortic Dissection"],"prefix":"10.3389","volume":"8","author":[{"given":"Penghong","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huashan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guochang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuqiang","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingxing","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.jtcvs.2013.10.036","article-title":"Similar cerebral protective effectiveness of antegrade and retrograde cerebral perfusion combined with deep hypothermia circulatory arrest in aortic arch surgery: a meta-analysis and systematic review of 5060 patients","volume":"148","author":"Hu","year":"2014","journal-title":"J Thor Cardiovasc Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"S105","DOI":"10.1016\/j.jtcvs.2014.07.098","article-title":"Frozen elephant trunk surgery in acute aortic dissection","volume":"149","author":"Di Bartolomeo","year":"2015","journal-title":"J Thor Cardiovasc Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1016\/j.jtcvs.2019.01.020","article-title":"Hybrid and frozen elephant trunk for total arch replacement in DeBakey type I dissection","volume":"158","author":"Zhang","year":"2019","journal-title":"J Thor Cardiovasc Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.iccl.2018.07.002","article-title":"Endovascular treatment options for the aortic arch","volume":"7","author":"Tanaka","year":"2018","journal-title":"Interv Cardiol Clin."},{"key":"B5","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1093\/ejcts\/ezt357","article-title":"Is the branched graft technique better than the en bloc technique for total aortic arch replacement?","volume":"45","author":"Shrestha","year":"2014","journal-title":"Eur J Cardio Thor Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.jtcvs.2015.03.002","article-title":"Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: preservation of autologous brachiocephalic vessels","volume":"150","author":"Zhu","year":"2015","journal-title":"J Thor Cardiovasc Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.asjsur.2018.09.011","article-title":"Supra-aortic vessel reconstruction in total arch replacement for acute type A dissection: comparison of en bloc and separate graft techniques","volume":"42","author":"Lin","year":"2019","journal-title":"Asian J Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1111\/jocs.14386","article-title":"Outcomes of different aortic arch replacement techniques","volume":"35","author":"Abjigitova","year":"2020","journal-title":"J Cardiac Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"R204","DOI":"10.1186\/cc2872","article-title":"Acute dialysis quality initiative w. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group","volume":"8","author":"Bellomo","year":"2004","journal-title":"Crit Care."},{"key":"B10","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/S0003-4975(01)03449-X","article-title":"Acute type A dissection: conservative methods provide consistently low mortality","volume":"73","author":"Westaby","year":"2002","journal-title":"Ann Thor Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1093\/ejcts\/ezt493","article-title":"Antegrade stenting of the descending thoracic aorta during DeBakey type 1 acute aortic dissection repair","volume":"45","author":"Di Eusanio","year":"2013","journal-title":"Eur J Cardio Thor Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1093\/ejcts\/ezu185","article-title":"Total aortic arch replacement with frozen elephant trunk in acute type A aortic dissections: are we pushing the limits too far?","volume":"47","author":"Shrestha","year":"2015","journal-title":"Eur J Cardio Thor Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1093\/ejcts\/ezy194","article-title":"Impact of reimplantation technique of supra-aortic branches in total arch replacement on stroke rate and survival: results from the ARCH registry","volume":"54","author":"Schoenhoff","year":"2018","journal-title":"Eur J Cardio Thor Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/j.jvs.2015.10.061","article-title":"Outcome of open total arch replacement in the modern era","volume":"63","author":"Settepani","year":"2016","journal-title":"J Vasc Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.athoracsur.2016.10.024","article-title":"The standardized concept of moderate-to-Mild (>\/=28 degrees C) systemic hypothermia during selective antegrade cerebral perfusion for all-comers in aortic arch surgery: single-center experience in 587 consecutive patients over a 15-year period","volume":"104","author":"El-Sayed Ahmad","year":"2017","journal-title":"Ann Thor Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1093\/ejcts\/ezu284","article-title":"Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe","volume":"47","author":"De Paulis","year":"2015","journal-title":"Eur J Cardio Thor Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.jtcvs.2019.01.127","article-title":"Aortic arch surgery with hypothermic circulatory arrest and unilateral antegrade cerebral perfusion: perioperative outcomes","volume":"159","author":"Wang","year":"2020","journal-title":"J Thorac Cardiovasc Surgry."},{"key":"B18","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.ejcts.2007.12.021","article-title":"Does anatomical completeness of the circle of willis correlate with sufficient cross-perfusion during unilateral cerebral perfusion?","volume":"33","author":"Urbanski","year":"2008","journal-title":"Eur J Cardio Thorac Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.athoracsur.2006.02.034","article-title":"Incomplete circle of Willis and right axillary artery perfusion","volume":"82","author":"Merkkola","year":"2006","journal-title":"Ann Thorac Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/S0022-5223(05)80009-1","article-title":"A 31p-magnetic resonance study of antegrade and retrograde cerebral perfusion during aortic arch surgery in pigs","volume":"110","author":"Filgueiras","year":"1995","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B21","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.ejcts.2004.04.002","article-title":"Hypothermic circulatory arrest with and without cold selective antegrade cerebral perfusion: impact on neurological recovery and tissue metabolism in an acute porcine model","volume":"26","author":"Hagl","year":"2004","journal-title":"Eur J Cardio Thorac Surg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"261","DOI":"10.3978\/j.issn.2225-319X.2013.05.11","article-title":"A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion","volume":"2","author":"Tian","year":"2013","journal-title":"Ann Cardiothorac Surg."},{"key":"B23","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1055\/s-0037-1604451","article-title":"Is more than one hour of selective antegrade cerebral perfusion in moderate-to-mild systemic hypothermic circulatory arrest for surgery of acute type a aortic dissection safe?","volume":"66","author":"El-Sayed Ahmad","year":"2018","journal-title":"Thorac Cardiovasc Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.jtcvs.2012.10.029","article-title":"Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: a meta-analysis of 5100 patients","volume":"147","author":"Angeloni","year":"2014","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B25","doi-asserted-by":"publisher","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 hypothermiadagger","volume":"51","author":"Zierer","year":"2017","journal-title":"Eur J Cardio Thorac Surg."},{"key":"B26","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1016\/j.jtcvs.2019.02.112","article-title":"Axillary artery cannulation reduces early embolic stroke and mortality after open arch repair with circulatory arrest","volume":"159","author":"Kim","year":"2020","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2936","DOI":"10.1016\/j.jtcvs.2014.05.082","article-title":"The impact of arterial cannulation strategy on operative outcomes in aortic surgery: evidence from a comprehensive meta-analysis of comparative studies on 4476 patients","volume":"148","author":"Benedetto","year":"2014","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B28","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1016\/j.ejcts.2004.12.042","article-title":"Technical problems and complications of axillary artery cannulation","volume":"27","author":"Schachner","year":"2005","journal-title":"Eur J Cardio Thorac Surg."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1016\/j.athoracsur.2006.10.068","article-title":"Axillary versus femoral cannulation for aortic surgery: enough evidence for a general recommendation?","volume":"83","author":"Gulbins","year":"2007","journal-title":"Ann Thorac Surg."},{"key":"B30","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1093\/ejcts\/ezu268","article-title":"Which cannulation (axillary cannulation or femoral cannulation) is better for acute type A aortic dissection repair? A meta-analysis of nine clinical studies","volume":"47","author":"Ren","year":"2015","journal-title":"Eur J Cardio Thorac Surg."},{"key":"B31","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.jtcvs.2018.11.100","article-title":"Outcome after aortic, axillary, or femoral cannulation for acute type A aortic dissection","volume":"158","author":"Kreibich","year":"2019","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"382","DOI":"10.5761\/atcs.oa.14-00250","article-title":"Impact of transapical aortic cannulation for acute type A aortic dissection","volume":"21","author":"Suenaga","year":"2015","journal-title":"Ann Thorac Cardiovasc Surg."},{"key":"B33","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1186\/s13019-020-01371-0","article-title":"Combined femoral and axillary perfusion strategy for Stanford type a aortic dissection repair","volume":"15","author":"Huang","year":"2020","journal-title":"J Cardiothor Surg."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e0211900","DOI":"10.1371\/journal.pone.0211900","article-title":"Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience","volume":"14","author":"Lin","year":"2019","journal-title":"PLoS ONE."},{"key":"B35","doi-asserted-by":"publisher","first-page":"557044","DOI":"10.3389\/fmed.2020.557044","article-title":"The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after surgery for acute type a aortic dissection: a single-center retrospective analysis of 335 patients","volume":"7","author":"Li","year":"2020","journal-title":"Front Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1016\/j.athoracsur.2020.07.019","article-title":"Acute kidney injury after acute repair of type a aortic dissection","volume":"111","author":"Helgason","year":"2021","journal-title":"Ann Thor Surg."},{"key":"B37","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s13019-019-0907-x","article-title":"Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study","volume":"14","author":"Xu","year":"2019","journal-title":"J Cardiothorac Surg."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1111\/aas.12946","article-title":"Renal tubular injury during cardiopulmonary bypass as assessed by urinary release of N-acetyl-ss-D-glucosaminidase","volume":"61","author":"Lannemyr","year":"2017","journal-title":"Acta Anaesthesiol Scand."},{"key":"B39","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1007\/s00540-011-1210-8","article-title":"Acute kidney injury during aortic arch surgery under deep hypothermic circulatory arrest","volume":"25","author":"Mori","year":"2011","journal-title":"J Anesth."},{"key":"B40","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1093\/ejcts\/ezx218","article-title":"Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years","volume":"52","author":"Shrestha","year":"2017","journal-title":"Eur J Cardio Thorac Surg."},{"key":"B41","doi-asserted-by":"publisher","first-page":"e003172","DOI":"10.1161\/JAHA.115.003172","article-title":"False lumen status in patients with acute aortic dissection: a systematic review and meta-analysis","volume":"5","author":"Li","year":"2016","journal-title":"J Am Heart Assoc."},{"key":"B42","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1148\/radiol.2291020905","article-title":"Descending thoracic aortic diseases: stent-graft repair","volume":"229","author":"Fattori","year":"2003","journal-title":"Radiology."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.727125\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T05:20:06Z","timestamp":1632806406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.727125\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,28]]},"references-count":42,"alternative-id":["10.3389\/fcvm.2021.727125"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.727125","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,28]]},"article-number":"727125"}}