{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:07:03Z","timestamp":1760123223235,"version":"3.41.2"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T00:00:00Z","timestamp":1676246400000},"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. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to compare the short- and long-term outcomes of proximal repair vs. extensive arch surgery for acute DeBakey type I aortic dissection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects<\/jats:title><jats:p>From April 2014 to September 2020, 121 consecutive patients with acute type A dissection were surgically treated at our institute. Of these patients, 92 had dissections extending beyond the ascending aorta.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Of the 92 patients, 58 underwent proximal repair, including aortic root and\/or hemiarch replacement, and 34 underwent extended repair, including partial and total arch replacement. Perioperative variables and early and late postoperative results were statistically analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The duration of surgery, cardiopulmonary bypass, and circulatory arrest was significantly shorter in the proximal repair group (<jats:italic>p\u2009<\/jats:italic>&amp;lt;\u20090.01). The overall operative mortality rate was 10.3% in the proximal repair group and 14.7% in the extended repair group (<jats:italic>p\u2009<\/jats:italic>=\u20090.379). The mean follow-up period was 31.1\u2009\u00b1\u200926.7 months in the proximal repair group and 35.3\u2009\u00b1\u200926.8 months in the extended repair group. During follow-up, the cumulative survival and freedom from reintervention rates at 5 years were 66.4% and 92.9% in the proximal repair group, and 76.1% and 72.6% in the extended repair group, respectively (<jats:italic>p\u2009<\/jats:italic>=\u20090.515 and <jats:italic>p\u2009<\/jats:italic>=\u20090.134).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>No significant differences were found in the rates of long-term cumulative survival and freedom from aortic reintervention between the two surgical strategies. These findings suggest limited aortic resection achieves acceptable patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1081167","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T05:15:10Z","timestamp":1676265310000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Proximal and extended aortic arch replacement in acute DeBakey type I aortic dissection"],"prefix":"10.3389","volume":"10","author":[{"given":"Masahiko","family":"Narita","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Tsutsui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryouhei","family":"Ushioda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuta","family":"Kikuchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomonori","family":"Shirasaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natsuya","family":"Ishikawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Kamiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,2,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1016\/j.jtcvs.2013.04.029","article-title":"Acute type A dissection without intimal tear in arch: proximal or extensive repair?","volume":"147","author":"Zhang","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/j.jtcvs.2015.03.068","article-title":"Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement","volume":"151","author":"Omura","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"156","DOI":"10.21037\/acs.2016.05.06","article-title":"Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis","volume":"5","author":"Poon","year":"2016","journal-title":"Ann Cardiothorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1093\/ejcts\/ezx214","article-title":"Extended versus limited arch replacement in acute type A aortic dissection","volume":"52","author":"Larsen","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1093\/ejcts\/ezab189","article-title":"Comparative outcomes of total arch versus hemiarch repair in acute DeBakey type I aortic dissection: the impact of 21 years of experience","volume":"60","author":"Ok","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/j.ejcts.2010.12.035","article-title":"Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection","volume":"40","author":"Kim","year":"2011","journal-title":"Eur J Cardiothorac Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1016\/j.jtcvs.2014.05.051","article-title":"Acute type A aortic dissection extending beyond ascending aorta: limited or extensive distal repair","volume":"148","author":"Rylski","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1161\/CIRCULATIONAHA.118.038867","article-title":"Interfacility transfer of medicare beneficiaries with acute type A aortic dissection and regionalization of care in the United States","volume":"140","author":"Goldstone","year":"2019","journal-title":"Circulation"},{"key":"B9","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1186\/s13019-020-01234-8","article-title":"Is limited aortic resection more justified in elderly patients with type A acute aortic dissection? 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