{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T03:36:02Z","timestamp":1792640162084,"version":"4.5.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"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:sec><jats:title>Background<\/jats:title><jats:p>Type A aortic dissection (TAAD) is a cardiovascular emergency condition with high mortality rate. Hybrid total aortic arch replacement using endovascular graft for the descending aorta repair results in favorable outcomes and has been recommended as an alternative procedure for the higher-risk category patients. Our institution started applying the upper ministernotomy incision technique for the hybrid procedures back in 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected patients who underwent hybrid total arch replacement (HTAR) via ministernotomy (96) and total arch replacement with frozen elephant trunk (TAR\u2009+\u2009FET) procedures (99), between 2018 and 2021. The baseline information, intraoperative and postoperative characteristics have been compared. Kaplan-Meier analysis was used for survival evaluation. Cox regression were applied to identify the independent predictor of mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The baseline characteristics between the two patient groups were compared and found similar, except that RBC counts were higher (<jats:italic>p<\/jats:italic>\u2009=\u20090.038) and the ascending aorta diameter was smaller (<jats:italic>P<\/jats:italic>\u2009=\u20090.019) in the \u201cHTAR\u201d group relative to the \u201cTAR\u2009+\u2009FET\u201d group. The cardiopulmonary bypass time (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001), the aortic cross clamp time (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001), the operation duration (<jats:italic>P<\/jats:italic>\u2009=\u2009.029), ICU (<jats:italic>P<\/jats:italic>\u2009=\u20090.037) and postoperative hospital stay (<jats:italic>P<\/jats:italic>\u2009=\u20090.002) were shorter in the \u201cHTAR\u201d group. The \u201cHTAR\u201d group exhibited also significantly lower levels of intraoperative transfusion (all &amp;lt;0.001) characteristics than the \u201cTAR\u2009+\u2009FET\u201d group. The hospital mortality and 1-year mortality revealed similar patterns in both groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>HTAR via ministernotomy have similar short term prognosis, and also reduced the ICU and postoperative hospital stay. In all, The application of the ministernotomy technique in HTAR was safe and technically feasible and may benefit individual patients as well as hospitals in general.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1231905","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T08:22:20Z","timestamp":1697617340000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Hybrid total arch replacement via ministernotomy for Stanford type A aortic dissection"],"prefix":"10.3389","volume":"10","author":[{"given":"Xing","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuehang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawei","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fayuan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingjian","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huadong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junwei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.avsg.2021.05.054","article-title":"Association of mental health disorders and aortic dissection","volume":"77","author":"Blakeslee-Carter","year":"2021","journal-title":"Ann Vasc Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1001\/jamacardio.2022.2718","article-title":"Early mortality in type a acute aortic dissection: insights from the international registry of acute aortic dissection","volume":"7","author":"Harris","year":"2022","journal-title":"Jama Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1161\/CIRCULATIONAHA.112.000483","article-title":"Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study","volume":"127","author":"Howard","year":"2013","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1016\/j.jtcvs.2017.04.088","article-title":"Long-term outcomes of frozen elephant trunk for type a aortic dissection in patients with marfan syndrome","volume":"154","author":"Ma","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.avsg.2019.10.075","article-title":"Impact of the frozen elephant trunk technique on total aortic arch replacement","volume":"65","author":"Hirano","year":"2020","journal-title":"Ann Vasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"392","DOI":"10.23736\/S0021-9509.20.11359-4","article-title":"Techniques and outcomes of total aortic arch repair with frozen elephant trunk for DeBakey I dissections","volume":"61","author":"Kawajiri","year":"2020","journal-title":"J Cardiovasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1053\/j.semtcvs.2015.12.004","article-title":"Endovascular repair of type a aortic dissection: current experience and technical considerations","volume":"28","author":"Horton","year":"2016","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1002\/bjs.10713","article-title":"Hybrid and total endovascular repair of the aortic arch","volume":"105","author":"Rudarakanchana","year":"2018","journal-title":"Br J Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"820653","DOI":"10.3389\/fcvm.2022.820653","article-title":"Hybrid technique on the total arch replacement for type a aortic dissection: 12-year clinical and radiographical outcomes from a single center","volume":"9","author":"Zhang","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B10","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 Thorac Cardiovasc Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1093\/icvts\/ivw355","article-title":"Classification and outcomes of extended arch repair for acute type a aortic dissection: a systematic review and meta-analysis","volume":"24","author":"Smith","year":"2017","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B12","article-title":"Minimally Invasive Aortic Valve Surgery","volume-title":"StatPearls","author":"Goyal","year":"2023"},{"key":"B13","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1007\/s11886-000-0041-2","article-title":"Minimal access aortic root, valve, and complex ascending aortic surgery","volume":"2","author":"Byrne","year":"2000","journal-title":"Curr Cardiol Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1016\/j.athoracsur.2009.04.060","article-title":"Minimally invasive approach for complex cardiac surgery procedures","volume":"88","author":"Totaro","year":"2009","journal-title":"Ann Thorac Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1016\/j.jvs.2005.01.043","article-title":"Endovascular repair of thoracic aortic lesions with the zenith TX1 and TX2 thoracic grafts: intermediate-term results","volume":"41","author":"Greenberg","year":"2005","journal-title":"J Vasc Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2027","DOI":"10.1016\/j.athoracsur.2014.02.045","article-title":"The impact of acute renal failure on early and late outcomes after thoracic aortic endovascular repair","volume":"97","author":"Drews","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.ejvs.2016.06.005","article-title":"Editor's choice - management of descending thoracic aorta diseases: clinical practice guidelines of the European society for vascular surgery (ESVS)","volume":"53","author":"Riambau","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1093\/ejcts\/ezy482","article-title":"The role of thoracic endovascular repair in elective, symptomatic and ruptured thoracic aortic diseases","volume":"56","author":"Fiorucci","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1177\/152660280000700510","article-title":"Endovascular repair of perisplanchnic abdominal aortic aneurysm with visceral vessel transposition","volume":"7","author":"Macierewicz","year":"2000","journal-title":"J Endovasc Ther"},{"key":"B20","doi-asserted-by":"publisher","first-page":"638420","DOI":"10.3389\/fcvm.2021.638420","article-title":"Early outcomes of three total arch replacement strategies for DeBakey type I aortic dissection","volume":"15","author":"Xie","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"621","DOI":"10.3978\/j.issn.2225-319X.2013.09.06","article-title":"Sun's procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type a aortic dissection","volume":"2","author":"Ma","year":"2013","journal-title":"Ann Cardiothorac Surg"},{"key":"B22","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/0003-4975(96)00418-3","article-title":"Minimally invasive approach for aortic valve operations","volume":"62","author":"Cosgrove","year":"1996","journal-title":"Ann Thorac Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1016\/S0003-4975(97)00927-2","article-title":"Minimal-access \u201cJ\u201d or \u201cj\u201d sternotomy for valvular, aortic, and coronary operations or reoperations","volume":"64","author":"Svensson","year":"1997","journal-title":"Ann Thorac Surg"},{"key":"B24","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":"B25","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/s0967-2109(02)00026-1","article-title":"Surgical results of aortic valve replacement via partial upper sternotomy: comparison with median sternotomy","volume":"10","author":"Masiello","year":"2000","journal-title":"Cardiovasc Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"944612","DOI":"10.3389\/fcvm.2022.944612","article-title":"Ministernotomy approach to aortic arch inclusion and frozen elephant trunk in the treatment of acute Stanford a aortic dissection","volume":"9","author":"Wang","year":"2022","journal-title":"Front Cardiovasc Med"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1231905\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T08:22:34Z","timestamp":1697617354000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1231905\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,18]]},"references-count":26,"alternative-id":["10.3389\/fcvm.2023.1231905"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1231905","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,18]]},"article-number":"1231905"}}