{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T21:30:18Z","timestamp":1789507818255,"version":"build-2803163510"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014103","name":"Key Technology Research and Development Program of Shandong","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014103","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The proximal anastomosis is an important procedure during the acute type A aortic dissection (AAAD) surgery. The conventional method is a double patch sandwich technique with Teflon felt. Adventitial eversion and prosthesis eversion technique as a novel approach has been applied to many patients in our center. Herein, This technique would be introduced, and the perioperative and 1-year follow-up results of the two different anastomosis methods were also evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between December 2017 and May 2021, 143 AAAD patients who underwent total arch replacement (TAR) and frozen elephant trunk (FET) implantation were included in this retrospective study. Patients were divided into the eversion technique group (adventitial eversion and prosthesis eversion technique for proximal anastomosis, <jats:italic>n<\/jats:italic> = 64) and the sandwich technique group (<jats:italic>n<\/jats:italic> = 79).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The medical records were analyzed and compared between the groups. The mean operation time was 466 \u00b1 73 min in the eversion technique group and 513 \u00b1 81 min in the sandwich technique group (<jats:italic>P<\/jats:italic> &amp;lt; 0.001). Compared with the sandwich technique group, the eversion technique group also showed a shorter time on proximal anastomosis (38 \u00b1 12 min vs. 58 \u00b1 20 min, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), cardiopulmonary bypass (195 \u00b1 26 vs. 211 \u00b1 40 min, <jats:italic>P<\/jats:italic> = 0.003), and aortic cross-clamp (120 \u00b1 23 min vs. 134 \u00b1 27 min, <jats:italic>P<\/jats:italic> = 0.002). Furthermore, a decreased proportion of &amp;gt;600 ml fresh frozen plasmas transfusion was observed in eversion technique group (10.9% vs. 34.2%, <jats:italic>P<\/jats:italic> = 0.002). No statistical differences were found in the postoperative morbidities and 1-year follow-up outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Proximal anastomosis with adventitial eversion and prosthesis eversion technique is a promising surgical option for AAAD patients, with favorable perioperative and 1-year follow-up results.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.1047939","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T04:43:46Z","timestamp":1666759426000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparison of two techniques in proximal anastomosis in acute type A aortic dissection"],"prefix":"10.3389","volume":"9","author":[{"given":"Changcun","family":"Fang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyan","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zengshan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"i29","DOI":"10.1093\/ejcts\/ezw341","article-title":"Total aortic arch replacement with the frozen elephant trunk procedure in acute DeBakey type I aortic dissections.","volume":"51","author":"Shrestha","year":"2017","journal-title":"Eur J Cardiothorac Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1536\/ihj.18-609","article-title":"A new aortic root reinforcement technique for acute type a aortic dissection surgery.","volume":"60","author":"Zhu","year":"2019","journal-title":"Int Heart J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/S0003-4975(03)00459-4","article-title":"A double patch sandwich technique for surgical repair of acute aortic dissection type A.","volume":"76","author":"Fleck","year":"2003","journal-title":"Ann Thorac Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.amjcard.2016.09.034","article-title":"Comparison of outcomes of operative therapy for acute type A aortic dissections provided at high-volume versus low-volume medical centers in north texas.","volume":"119","author":"Arsalan","year":"2017","journal-title":"Am J Cardiol."},{"key":"B5","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1016\/j.jacc.2010.02.015","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. 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