{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:07:13Z","timestamp":1785863233460,"version":"3.56.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005047","name":"Natural Science Foundation of Liaoning Province","doi-asserted-by":"publisher","award":["2020JH2\/10300161"],"award-info":[{"award-number":["2020JH2\/10300161"]}],"id":[{"id":"10.13039\/501100005047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005047","name":"Natural Science Foundation of Liaoning Province","doi-asserted-by":"publisher","award":["2020-KF-12-01"],"award-info":[{"award-number":["2020-KF-12-01"]}],"id":[{"id":"10.13039\/501100005047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005047","name":"Natural Science Foundation of Liaoning Province","doi-asserted-by":"publisher","award":["XLYC2007053"],"award-info":[{"award-number":["XLYC2007053"]}],"id":[{"id":"10.13039\/501100005047","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>Minimally invasive total arch replacement (TAR) with frozen elephant trunk (FET) implantation can be carried out through J-, L-, and inverted T-shaped upper ministernotomy. L- and inverted T-shaped upper ministernotomy are selected mostly for their better surgical view compared to J-shaped. However, few studies have paid attention to the difference in clinical effects between J- and L-shaped upper hemisternotomy in acute Type A aortic dissection (ATAAD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>We retrospectively analyzed 74 consecutive patients with ATAAD who underwent TAR with FET implantation between December 2019 and October 2020. Patients were divided into the L group (<jats:italic>n<\/jats:italic> = 31, L-shaped upper hemisternotomy) and the J group (<jats:italic>n<\/jats:italic> = 43, J-shaped upper hemisternotomy). Perioperative characteristics were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No significant difference was found in any of the pre-operative, post-operative, or follow-up variables between the two groups. However, the CPB establishment time in the J group was significantly shorter than that in the L group (65.0 \u00b1 17.9 min vs. 77.9 \u00b1 17.2 min, <jats:italic>P<\/jats:italic> &amp;lt; 0.05). Other intraoperative variables showed no significant difference.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Total arch replacement with frozen elephant trunk implantation is feasible and can be carried out safely through J-shaped or L-shaped incision. A J-shaped incision might be beneficial for single incision, while an L-shaped incision might be beneficial if an extra incision is required to achieve better artery perfusion.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.998139","type":"journal-article","created":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T05:55:05Z","timestamp":1668059705000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Both J- and L-shaped upper hemisternotomy approaches are suitable for total arch replacement with frozen elephant trunk in patients with Type A dissection"],"prefix":"10.3389","volume":"9","author":[{"given":"Zhonglu","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuguang","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huishan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.ccl.2017.03.004","article-title":"Acute type A aortic dissection.","volume":"35","author":"Elsayed","year":"2017","journal-title":"Cardiol Clin."},{"key":"B2","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1177\/0218492320951304","article-title":"Frozen elephant trunk usage in acute aortic dissection.","volume":"29","author":"Okita","year":"2021","journal-title":"Asian Cardiovasc Thorac Ann."},{"key":"B3","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","year":"2011","journal-title":"Circulation."},{"key":"B4","first-page":"665","article-title":"Sun\u2019s procedure for chronic type A aortic dissection: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation.","volume":"2","author":"Sun","year":"2013","journal-title":"Ann Cardiothorac Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.athoracsur.2007.03.029","article-title":"Minimal access surgery of ascending and proximal arch of the aorta: a 9-year experience.","volume":"84","author":"Tabata","year":"2007","journal-title":"Ann Thorac Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1016\/j.jtcvs.2008.08.010","article-title":"Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis.","volume":"137","author":"Brown","year":"2009","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1016\/S0003-4975(01)03402-6","article-title":"Does ministernotomy improve postoperative outcome in aortic valve operation? A prospective randomized study.","volume":"73","author":"Bonacchi","year":"2002","journal-title":"Ann Thorac Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1016\/j.athoracsur.2005.12.011","article-title":"Minimally invasive versus standard approach aortic valve replacement: a study in 506 patients.","volume":"81","author":"Bakir","year":"2006","journal-title":"Ann Thorac Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"E345","DOI":"10.1532\/hsf.3729","article-title":"Mild hypothermic circulatory arrest with lower body perfusion for total arch replacement via upper hemisternotomy in acute type A dissection.","volume":"24","author":"Jiang","year":"2021","journal-title":"Heart Surg Forum."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1394","DOI":"10.1016\/j.athoracsur.2019.08.095","article-title":"Total arch replacement via single upper-hemisternotomy approach in patients with type A dissection.","volume":"109","author":"Jiang","year":"2020","journal-title":"Ann Thorac Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1007\/s11748-018-0913-2","article-title":"Early results of total arch replacement under partial sternotomy.","volume":"66","author":"Inoue","year":"2018","journal-title":"Gen Thorac Cardiovasc Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1093\/ejcts\/ezv484","article-title":"Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique.","volume":"50","author":"El-Sayed","year":"2016","journal-title":"Eur J Cardiothorac Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jtcvs.2005.09.015","article-title":"Should the \u201celephant trunk\u201d be skeletonized? 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