{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T02:03:56Z","timestamp":1784685836517,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T00:00:00Z","timestamp":1663027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012245","name":"Science and Technology Planning Project of Guangdong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012245","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>Objective<\/jats:title><jats:p>The aim of the study was to investigate surgical modalities and outcomes in patients with type A aortic dissection involving arch anomalies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Patients with type A aortic dissection who underwent surgical treatment at our center between January 2017 and 31 December 2020 were selected for this retrospective analysis. Data including computed tomography (CT), surgical records, and cardiopulmonary bypass records were analyzed. Perioperatively survived patients were followed up, and long-term mortality and aortic re-interventions were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>A total of 81 patients with arch anomalies were included, 35 with \u201cbovine\u201d anomalies, 23 with an aberrant right subclavian artery, 22 with an isolated left vertebral artery, and one with a right-sided arch + aberrant left subclavian artery. The strategies of arch management and cannulation differed according to the anatomic variation of the aortic arch. In total, seven patients (9%) died after surgery. Patients with \u201cbovine\u201d anomalies had a higher perioperative mortality rate (14%) and incidence of neurological complications (16%). Overall, four patients died during the follow-up period, with a 6-year survival rate of 94.6% (70\/74). A total of four patients underwent aortic re-intervention during the follow-up period; before the re-intervention, three received the <jats:italic>en bloc<\/jats:italic> technique (13.6% 3\/22) and one received hybrid therapy (11.1% 1\/9).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>With complete preservation and reconstruction of the supra-arch vessels, patients with type A aortic dissection combining arch anomalies can achieve a favorable perioperative prognostic outcome. Patients who received the <jats:italic>en bloc<\/jats:italic> technique are more likely to require aortic re-intervention than patients who underwent total arch replacement with a four-branched graft vessel. Cannulation strategies should be tailored according to the variation of anatomy, but routine cannulation with the right axillary artery can still be performed in most patients with arch anomalies, even for patients with an aberrant right subclavian artery.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.979431","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T06:19:35Z","timestamp":1663049975000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Surgical treatment strategies for patients with type A aortic dissection involving arch anomalies"],"prefix":"10.3389","volume":"9","author":[{"given":"Jiade","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guang","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donglin","family":"Zhuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongchao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhichao","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaorong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changjiang","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZeRui","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jue","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruixin","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tucheng","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinlin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/j.crad.2010.02.003","article-title":"Frequency of variations in aortic arch anatomy depicted on multidetector CT","volume":"65","author":"Jakanani","year":"2010","journal-title":"Clin Radiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1640","DOI":"10.1016\/j.jvs.2018.03.409","article-title":"Association of variant arch anatomy with type B aortic dissection and hemodynamic mechanisms","volume":"68","author":"Sherene Shalhub","year":"2018","journal-title":"J Vasc Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s11748-018-1001-3","article-title":"Anatomical variations of aortic arch vessels in Japanese patients with aortic arch disease","volume":"67","author":"Yuki Ikeno","year":"2019","journal-title":"Gen Thorac Cardiovasc Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1093\/ejcts\/ezaa029","article-title":"Total arch replacement and frozen elephant trunk for aortic dissection in aberrant right subclavian artery","volume":"58","author":"Li","year":"2020","journal-title":"Eur J Cardiothorac Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1053\/j.jvca.2013.12.001","article-title":"Congenital anomalies of the aortic arch in acute type-A aortic dissection: implications for monitoring, perfusion strategy, and surgical repair","volume":"28","author":"Bryan","year":"2014","journal-title":"J Cardiothorac Vasc Anesth."},{"key":"B6","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1016\/j.ejvs.2017.09.014","article-title":"Morphology and outcomes of total endovascular treatment of type B aortic dissection with aberrant right subclavian artery","volume":"54","author":"Zhou","year":"2017","journal-title":"Eur J Vasc Endovasc Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1016\/j.jvs.2017.07.124","article-title":"Outcomes of hybrid procedure for type B aortic dissection with an aberrant right subclavian artery","volume":"67","author":"Ding","year":"2018","journal-title":"J Vasc Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1016\/j.jvir.2019.02.001","article-title":"Midterm outcomes of endovascular repair for stanford type B aortic dissection with aberrant right subclavian artery","volume":"30","author":"Zhang WC Li","year":"2019","journal-title":"J Vasc Interv Radiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.athoracsur.2014.05.086","article-title":"Bovine aortic arch: predictor of entry site and risk factor for neurologic injury in acute type a dissection","volume":"98","author":"Dumfarth","year":"2014","journal-title":"Ann Thorac Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1093\/ejcts\/ezaa407","article-title":"Prior reconstruction of an isolated left vertebral artery for Stanford type A aortic dissection","volume":"59","author":"Zuo","year":"2021","journal-title":"Eur J Cardiothorac Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1016\/j.jvs.2018.11.052","article-title":"Management of type B aortic dissection with an isolated left vertebral artery","volume":"70","author":"Ding","year":"2019","journal-title":"J Vasc Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.athoracsur.2012.07.078","article-title":"Total arch replacement in patients with aortic dissection with an isolated left vertebral artery","volume":"95","author":"Qi","year":"2013","journal-title":"Ann Thorac Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1161\/CIRCULATIONAHA.110.015081","article-title":"Total arch replacement combined with stented elephant trunk implantation A new \u201cStandard\u201d therapy for Type A dissection involving repair of the aortic arch?","volume":"123","author":"Sun LZ Qi","year":"2011","journal-title":"Circulation."},{"key":"B14","doi-asserted-by":"publisher","first-page":"642","DOI":"10.12945\/j.aorta.2013.13.015.vid.01","article-title":"Sun's procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation","volume":"2","author":"Ma","year":"2013","journal-title":"Ann Cardiothorac Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"5376","DOI":"10.21037\/jtd.2018.08.140","article-title":"Frozen elephant trunk with modified en bloc arch reconstruction and left subclavian transposition for chronic type A dissection","volume":"10","author":"Zhong","year":"2018","journal-title":"J Thorac Dis."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.athoracsur.2013.01.044","article-title":"Aberrant right subclavian artery and axillary artery cannulation in type A aortic dissection repair","volume":"96","author":"Bektas","year":"2013","journal-title":"Ann Thorac Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/j.jtcvs.2016.10.064","article-title":"Postoperative myocardial infarction in acute type A aortic dissection: A report from the International Registry of Acute Aortic Dissection","volume":"153","author":"Stephen","year":"2017","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e694","DOI":"10.1097\/MD.0000000000000694","article-title":"Outcome of frozen elephant trunk technique for acute type A aortic dissection: as systematic review and meta-analysis","volume":"94","author":"Lin","year":"2015","journal-title":"Medicine (Baltimore)."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.979431\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T06:19:38Z","timestamp":1663049978000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.979431\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,13]]},"references-count":18,"alternative-id":["10.3389\/fcvm.2022.979431"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.979431","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,13]]},"article-number":"979431"}}