{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T04:32:11Z","timestamp":1776573131127,"version":"3.51.2"},"reference-count":23,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Berta-Ottenstein-Programme for Advanced Clinician Scientists, Faculty of Medicine, University of Freiburg"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Our aim was to investigate outcomes and long-term survival in male and female patients after frozen elephant trunk (FET) total arch replacement. Methods: Between March 2013 and January 2023, 362 patients underwent aortic arch replacement via the FET technique. We compared patient characteristics and intra- and postoperative data between male and female patients. Results: Male patients were significantly younger (p = 0.012) but revealed a higher incidence of coronary artery disease (p = 0.008) and preoperative dialysis (p = 0.017). More male patients presented with type A aortic dissections (p = 0.042) while more female patients had aortic aneurysms (p = 0.025). The aortic root was replaced in significantly more male patients (p = 0.013), resulting in significantly longer cardiopulmonary bypass duration (p &lt; 0.001) and operative times (p &lt; 0.001). There were no statistically significant differences in postoperative outcome parameters including in-hospital mortality (p = 0.346). However, new in-stent thrombus formation was significantly more frequent in female patients (p = 0.002). Age in years (odds ratio (OR): 1.026, p = 0.049), an acute pathology (OR: 1.941, p = 0.031) and preoperative dialyses (OR: 3.499, p = 0.010) were predictive for long-term mortality in our Cox regression model, sex (p = 0.466) was not. There was no statistical difference in overall survival (log rank: p = 0.425). Conclusions: Female patients are older but reveal fewer cardiovascular risk factors; aneurysms are more common in female than male patients. As female patients undergo concomitant surgical procedures less often, their operative times are shorter. While survival and outcomes were similar, female patients suffered from postoperative new in-stent thrombus formation significantly more often.<\/jats:p>","DOI":"10.3390\/jcm12196327","type":"journal-article","created":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T04:39:30Z","timestamp":1696221570000},"page":"6327","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparative Study of Male and Female Patients Undergoing Frozen Elephant Trunk Total Arch Replacement"],"prefix":"10.3390","volume":"12","author":[{"given":"Julia","family":"Benk","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stoyan","family":"Kondov","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"D\u2019Inka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magdalena","family":"Bork","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Discher","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bartosz","family":"Rylski","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Czerny","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Kreibich","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1093\/ejcts\/ezv085","article-title":"Current status and recommendations for use of the frozen elephant trunk technique: A position paper by the Vascular Domain of EACTS","volume":"47","author":"Shrestha","year":"2015","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1161\/CIR.0000000000001106","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":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e013260","DOI":"10.1161\/JAHA.119.013260","article-title":"Sex Differences in Long-Term Survival After Major Cardiac Surgery: A Population-Based Cohort Study","volume":"8","author":"Johnston","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e058538","DOI":"10.1136\/bmjopen-2021-058538","article-title":"Sex differences in risks of in-hospital and late outcomes after cardiac surgery: A nationwide population-based cohort study","volume":"12","author":"Chang","year":"2022","journal-title":"BMJ Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"505","DOI":"10.23736\/S0021-9509.19.10893-2","article-title":"Evaluation of myocardial injury, the need for vasopressors and inotropic support in beating-heart aortic arch surgery","volume":"61","author":"Berger","year":"2020","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1093\/icvts\/ivz281","article-title":"Aortic dissection reconsidered: Type, entry site, malperfusion classification adding clarity and enabling outcome prediction","volume":"30","author":"Sievers","year":"2020","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1161\/STROKEAHA.117.017866","article-title":"Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials","volume":"48","author":"Broderick","year":"2017","journal-title":"Stroke"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1161\/CIRCULATIONAHA.118.035805","article-title":"Sex-Related Differences in Patients Undergoing Thoracic Aortic Surgery","volume":"139","author":"Chung","year":"2019","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.cjco.2022.08.012","article-title":"Sex Differences in Trends in Incidence of Thoracic Aortic Aneurysm Repair and Aortic Dissection: 2005\u20132015","volume":"4","author":"Cote","year":"2022","journal-title":"CJC Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.jtcvs.2017.05.089","article-title":"Are outcomes of thoracoabdominal aortic aneurysm repair different in men versus women? A propensity-matched comparison","volume":"154","author":"Spiliotopoulos","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1161\/HYPERTENSIONAHA.118.11851","article-title":"Sex Differences in Thoracic Aortic Aneurysm Growth","volume":"73","author":"Boczar","year":"2019","journal-title":"Hypertension"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1093\/ejcts\/ezv356","article-title":"Mortality in patients with acute aortic dissection type A: Analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA)","volume":"49","author":"Conzelmann","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3014","DOI":"10.1161\/01.CIR.0000130644.78677.2C","article-title":"Gender-related differences in acute aortic dissection","volume":"109","author":"Nienaber","year":"2004","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"ezad112","DOI":"10.1093\/ejcts\/ezad112","article-title":"Acute type A aortic dissection in adolescents and young adults under 30 years of age: Demographics, aetiology and postoperative outcomes of 139 cases","volume":"63","author":"Luehr","year":"2023","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1161\/CIRCULATIONAHA.110.006320","article-title":"Correlates of delayed recognition and treatment of acute type A aortic dissection: The International Registry of Acute Aortic Dissection (IRAD)","volume":"124","author":"Harris","year":"2011","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1097\/CM9.0000000000000443","article-title":"Association between cardiopulmonary bypass time and 90-day post-operative mortality in patients undergoing arch replacement with the frozen elephant trunk: A retrospective cohort study","volume":"132","author":"Zheng","year":"2019","journal-title":"Chin. Med. J. (Engl.)"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jtcvs.2016.02.077","article-title":"Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Single-center results of the first 100 patients","volume":"152","author":"Shrestha","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"ezac051","DOI":"10.1093\/ejcts\/ezac051","article-title":"Frozen elephant trunk in acute aortic type a dissection: Risk analysis of concomitant root replacement","volume":"62","author":"Beckmann","year":"2022","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.jtcvs.2019.09.194","article-title":"Sex differences in thoracic aortic disease: A review of the literature and a call to action","volume":"160","author":"Chung","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"921479","DOI":"10.3389\/fcvm.2022.921479","article-title":"Postoperative In-Stent Thrombus Formation Following Frozen Elephant Trunk Total Arch Repair","volume":"9","author":"Walter","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Martens, A., Beckmann, E., Kaufeld, T., Arar, M., Natanov, R., Fleissner, F., Korte, W., Krueger, H., Boethig, D., and Haverich, A. (2023). Features and risk factors of early intraluminal thrombus formation within the frozen elephant trunk stent graft. J. Thorac. Cardiovasc. Surg.","DOI":"10.1016\/j.jtcvs.2023.01.014"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ibrahim, M., Chung, J.C., Ascaso, M., Hage, F., Chu, M.W.A., Boodhwani, M., Sheikh, A.A., Leroux, E., Ouzounian, M., and Peterson, M.D. (2022). In-hospital thromboembolic complications after frozen elephant trunk aortic arch repair. J. Thorac. Cardiovasc. Surg.","DOI":"10.1016\/j.jtcvs.2022.08.005"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/19\/6327\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:03:50Z","timestamp":1760130230000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/19\/6327"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,1]]},"references-count":23,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jcm12196327"],"URL":"https:\/\/doi.org\/10.3390\/jcm12196327","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,1]]}}}