{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T08:36:23Z","timestamp":1773995783463,"version":"3.50.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"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>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Acute aortic syndrome (AAS) with an inadequate proximal landing zone often requires aortic arch reconstruction using endovascular branch techniques or hybrid supra-aortic debranching plus TEVAR. Despite technical advances, early postoperative stroke remains a clinically important complication. Procedure duration may reflect procedural complexity and cumulative cerebral embolic\/hypoperfusion burden, yet its association with early stroke after contemporary arch reconstruction strategies is not well characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed consecutive AAS patients undergoing aortic arch reconstruction with either Zone 2 single-branch stent-assisted TEVAR or hybrid surgery (supra-aortic bypass with subsequent TEVAR) between January 2017 and December 2023. The primary endpoint was ischemic stroke within 30 days after the procedure, confirmed by imaging. We evaluated the relationship between procedure duration and early stroke using multivariable regression models adjusting for key clinical confounders (age, sex, BMI, hypertension, diabetes, coronary artery disease, prior stroke, and renal insufficiency). Discriminative performance for procedure time was explored using ROC analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 235 patients were included (mean age 60.7\u2009\u00b1\u200910.6 years; 84.7% male). Procedure duration was longer in the hybrid group than in the Zone 2 single-branch TEVAR group (249.0\u2009\u00b1\u200972.3 vs. 110.4\u2009\u00b1\u200943.3\u2005min,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Early postoperative stroke occurred in 17 patients (7.2%), with a higher incidence in the hybrid group than in the Zone 2 single-branch TEVAR group (11.1% vs. 3.9%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.034). Procedure duration was independently associated with early stroke after adjustment (adjusted HR 1.012 per minute, 95% CI 1.006\u20131.018;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). In exploratory analyses, a procedure-time cut-point of 273\u2005min showed good discrimination for early stroke (AUC\u2009=\u20090.81).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this single-center cohort of AAS patients undergoing aortic arch reconstruction, longer procedure duration was associated with a higher risk of early postoperative stroke, independent of measured comorbidities. Procedure duration may serve as a pragmatic marker of procedural complexity and cerebral risk exposure, supporting quality-improvement efforts aimed at workflow optimization and risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1772103","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T05:23:05Z","timestamp":1773984185000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Procedure duration and early postoperative stroke after endovascular and hybrid aortic arch reconstruction for acute aortic syndrome: a single-center retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Haoze","family":"Li","sequence":"first","affiliation":[{"name":"Interventional Diagnosis and Treatment Center, Mudanjiang Cardiovascular Disease Hospital","place":["Mudanjiang, Heilongjiang Province, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junzhou","family":"Pu","sequence":"additional","affiliation":[{"name":"Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenhui","family":"Wu","sequence":"additional","affiliation":[{"name":"Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiqi","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Interventional Vascular, Affiliated Suzhou Hospital of Nanjing Medical University","place":["Suzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhang","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Interventional Vascular, Affiliated Suzhou Hospital of Nanjing Medical University","place":["Suzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC guidelines for the management of peripheral arterial and aortic diseases","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e334","DOI":"10.1016\/j.jacc.2022.08.004","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology joint committee on clinical practice guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/j.jtcvs.2021.11.091","article-title":"The society of thoracic surgeons\/American association for thoracic surgery clinical practice guidelines on the management of type B aortic dissection","volume":"163","author":"MacGillivray","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/j.jvs.2019.11.013","article-title":"Society for vascular surgery (SVS) and society of thoracic surgeons (STS) reporting standards for type B aortic dissections","volume":"71","author":"Lombardi","year":"2020","journal-title":"J Vasc Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13051231","article-title":"Acute aortic syndromes from diagnosis to treatment-A","volume":"13","author":"Banceu","year":"2024","journal-title":"Comprehensive Review. 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