{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T01:46:06Z","timestamp":1789263966818,"version":"build-2803163510"},"reference-count":63,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute Stanford Type A aortic dissection (ATAAD) often requires total arch replacement (TAR) with frozen elephant trunk (FET) to address entry tears and support aortic remodeling. In select cases, AMDS may provide a simpler option. The present meta-analysis aims to compare surgical outcomes between these two approaches. Methods: A comprehensive search in the Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases was performed until February 2025. We included studies that reported the outcomes of patients with ATAAD undergoing TAR with AMDS or FET. To enable a meaningful comparison, we only included FET studies where patients met the same inclusion criteria as those with the AMDS. Results: Thirty-eight articles met our inclusion criteria, with a total of 319 patients in the AMDS group and 4129 in the FET group. Patients undergoing an AMDS procedure experienced significantly higher bleeding requiring surgery (21.2% vs. 6.4%, p &lt; 0.001) and a higher hospital mortality (14.5% vs. 10.0%, p = 0.037) compared to FET. The individual patient data of 1411 patients were constructed. Overall survival at 1 and 3 years was 81.9% \u00b1 3.3% vs. 88.8% \u00b1 0.9% and 81.9% \u00b1 3.3% vs. 85.2% \u00b1 1.0% between AMDS and FET, respectively. A flexible parametric survival model demonstrated a significant mortality drawback for AMDS compared to FET up to 31 days, beyond which the difference was no longer evident. Conclusions: The comparison between AMDS and FET for ATAAD treatment remains debated, with FET favored for its lower mortality and stronger long-term evidence. AMDS, as a newer technique, shows promise but lacks sufficient data to confirm its safety and efficacy.<\/jats:p>","DOI":"10.3390\/jcm14145170","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T14:55:18Z","timestamp":1753109718000},"page":"5170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Total Arch Replacement with Ascyrus Medical Dissection Stent Versus Frozen Elephant Trunk in Acute Type A Aortic Dissection: A Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3754-6704","authenticated-orcid":false,"given":"Massimo","family":"Baudo","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1475-3156","authenticated-orcid":false,"given":"Fabrizio","family":"Rosati","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3971-4145","authenticated-orcid":false,"given":"Michele","family":"D\u2019Alonzo","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Poliambulanza Hospital Brescia, 25124 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7962-7276","authenticated-orcid":false,"given":"Antonio","family":"Fiore","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, H\u00f4pitaux Universitaires Henri Mondor, Assistance Publique-H\u00f4pitaux de Paris, F-94000 Cr\u00e9teil, France"},{"name":"CEpiA Team, IMRB U955, Inserm, Universit\u00e9 Paris Est Cr\u00e9teil, F-94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2656-4544","authenticated-orcid":false,"given":"Claudio","family":"Muneretto","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Benussi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0343-511X","authenticated-orcid":false,"given":"Lorenzo","family":"Di Bacco","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1016\/j.jacc.2020.07.061","article-title":"Type A Aortic Dissection-Experience Over 5 Decades: JACC Historical Breakthroughs in Perspective","volume":"76","author":"Zhu","year":"2020","journal-title":"J. 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