{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T01:42:24Z","timestamp":1783820544853,"version":"3.55.0"},"reference-count":176,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"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: Aortic arch surgery using the frozen elephant trunk (FET) technique remains one of the most complex scenarios in cardiac anesthesia. The anesthesiologist plays a central role in maintaining neuroprotection, organ perfusion and hemodynamic stability during hypothermic circulatory arrest and selective cerebral perfusion. This review summarizes key anesthetic principles aimed at improving neurologic and systemic outcomes. Methods: This narrative review examines current evidence and expert recommendation on temperature and perfusion management, neuromonitoring, coagulation control and postoperative strategies specific to FET procedures. Results: Modern approaches emphasize moderate hypothermia with tailored selective cerebral perfusion, multimodal neuromonitoring and structured organ protection bundles. Evidence supports the use of physiology-guided perfusion, viscoelastic-based coagulation management and coordinated teamwork with surgical and perfusion specialists to reduce neurologic injury, bleeding and postoperative organ dysfunction. Conclusions: Anesthetic management in FET surgery requires an integrated, physiology-based strategy supported by advanced monitoring and close interdisciplinary coordination. Adoption of standardized organ-protection and perfusion protocols is essential to optimize neurologic and systemic outcomes in this high-risk population.<\/jats:p>","DOI":"10.3390\/jcm15020877","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:31:46Z","timestamp":1769009506000},"page":"877","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Aortic Arch and Frozen Elephant Trunk Surgery: Anesthetic Challenges and Strategies for Organ Protection"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5046-4275","authenticated-orcid":false,"given":"Debora Emanuela","family":"Torre","sequence":"first","affiliation":[{"name":"Intensive Care Unit and Cardiac Surgery, Department of Cardiac Anesthesia, Ospedale dell\u2019Angelo, 30174 Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-6549","authenticated-orcid":false,"given":"Carmelo","family":"Pirri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"708","DOI":"10.21037\/cdt-22-330","article-title":"The frozen elephant trunk procedure: Indications, outcomes and future directions","volume":"12","author":"Acharya","year":"2022","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_2","first-page":"II188","article-title":"New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft","volume":"94","author":"Kato","year":"1996","journal-title":"Circulation"},{"key":"ref_3","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_4","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1080\/17434440.2024.2326539","article-title":"Thoraflex Hybrid Prosthesis (THP): The profile","volume":"21","author":"Jubouri","year":"2024","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"427","DOI":"10.21470\/1678-9741-2019-0220","article-title":"Which is the Optimal Frozen Elephant Trunk? A Systematic Review and Meta-Analysis of Outcomes in 2161 Patients Undergoing Thoracic Aortic Aneurysm Surgery Using E-vita OPEN PLUS Hybrid Stent Graft versus ThoraflexTM Hybrid Prosthesis","volume":"35","author":"Harky","year":"2020","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s12055-021-01303-0","article-title":"NEO E-vita-NEO era!","volume":"38","author":"Jakob","year":"2022","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Baudo, M., D\u2019Alonzo, M., Muneretto, C., Benussi, S., Di Bacco, L., and Rosati, F. (2025). Unilateral vs. Bilateral Selective Cerebral Perfusion for Acute Type A Aortic Dissection with Frozen Elephant Trunk: Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14186392"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cui, Y., Liu, X., Xiong, J., Tan, Z., Du, L., and Lin, J. (2023). Cardiopulmonary bypass for total aortic arch replacement surgery: A review of three techniques. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1109401"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.athoracsur.2017.06.072","article-title":"Safety of Moderate Hypothermia with Antegrade Cerebral Perfusion in Total Aortic Arch Replacement","volume":"105","author":"Keeling","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1093\/ejcts\/ezr304","article-title":"Antegrade selective cerebral perfusion and moderate hypothermia in aortic arch surgery: Clinical outcomes in elderly patients","volume":"42","author":"Pacini","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1093\/icvts\/ivx432","article-title":"The risk of spinal cord injury during the frozen elephant trunk procedure in acute aortic dissection","volume":"26","author":"Kozlov","year":"2018","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s11748-019-01196-2","article-title":"Risk factors for spinal cord injury in patients undergoing frozen elephant trunk technique for acute aortic dissection","volume":"68","author":"Hori","year":"2020","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"880","DOI":"10.21037\/cdt-22-313","article-title":"Risk factors for severe acute kidney injury post complication after total arch replacement combined with frozen elephant trunk, in acute type A aortic dissection","volume":"12","author":"Chen","year":"2022","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Torre, D.E., and Pirri, C. (2025). Spinal cord protection in open and endovascular aortic surgery: Current strategies, controversies and future directions. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1671350"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1053\/j.jvca.2019.06.030","article-title":"Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis, Meta-Regression, and Trial Sequential Analysis","volume":"34","author":"Meco","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/anae.16463","article-title":"Viscoelastic haemostatic assays to guide therapy in elective surgery: An updated systematic review and meta-analysis","volume":"80","author":"Dias","year":"2025","journal-title":"Anaesthesia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"623","DOI":"10.21037\/cdt-23-144","article-title":"Frozen elephant trunk: The gold standard","volume":"13","author":"Bashir","year":"2023","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.21037\/cdt-23-300","article-title":"Evidence-based frozen elephant trunk practice: A narrative review","volume":"13","author":"Kayali","year":"2023","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Rahman, I., Ali, J., and De Silva, R. (2025). Cannulation Strategies for Aortic Arch Surgery. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12090360"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.jtcvs.2019.02.112","article-title":"Axillary artery cannulation reduces early embolic stroke and mortality after open arch repair with circulatory arrest","volume":"159","author":"Kim","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_21","first-page":"310","article-title":"Direct versus side-graft cannulation of the right axillary artery for antegrade cerebral perfusion","volume":"33","author":"Yilik","year":"2006","journal-title":"Tex. Heart Inst. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/j.athoracsur.2009.12.005","article-title":"Cannulation of the innominate artery with a side graft in arch surgery","volume":"89","author":"Huang","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/jocs.13091","article-title":"Innominate artery cannulation for arterial perfusion during aortic arch surgery","volume":"32","author":"Uchino","year":"2017","journal-title":"J. Card. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1186\/s13019-022-01928-1","article-title":"Left axillary cannulation for acute type A aortic dissection","volume":"17","author":"Sun","year":"2022","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.xjtc.2023.08.020","article-title":"Total aortic arch replacement without deep hypothermic circulatory arrest in type A aortic dissection: Left axillar artery for arterial cannulation","volume":"22","author":"Kiziltepe","year":"2023","journal-title":"JTCVS Tech."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"5027","DOI":"10.1111\/jocs.17175","article-title":"Validity of direct bilateral axillary arterial cannulation in emergency surgery for acute type A aortic dissection","volume":"37","author":"Suzuki","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"671","DOI":"10.21037\/jtd-20-2113","article-title":"Femoral artery cannulation as a safe alternative for aortic dissection arch repair in the era of axillary artery cannulation","volume":"13","author":"Tong","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1093\/ejcts\/ezv035","article-title":"Axillary versus femoral arterial cannulation in type A acute aortic dissection: Evidence from a meta-analysis of comparative studies and adjusted risk estimates","volume":"48","author":"Benedetto","year":"2015","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.xjon.2023.01.017","article-title":"Central aortic versus axillary artery cannulation for aortic arch surgery","volume":"14","author":"Chung","year":"2023","journal-title":"JTCVS Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.jtcvs.2006.09.059","article-title":"Central cannulation is safe in acute aortic dissection repair","volume":"133","author":"Reece","year":"2007","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1080\/14796678.2024.2367875","article-title":"Double arterial vs. single axillary cannulation in acute type A aortic dissections: A meta-analysis","volume":"20","author":"Yamashita","year":"2024","journal-title":"Future Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"807","DOI":"10.3346\/jkms.2009.24.5.807","article-title":"Unilateral antegrade selective cerebral perfusion in aortic surgery: Clinical outcomes at different levels of hypothermia","volume":"24","author":"Lee","year":"2009","journal-title":"J. Korean Med. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1051\/ject\/201648122","article-title":"Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement","volume":"48","author":"Maier","year":"2016","journal-title":"J. Extra Corpor. Technol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.xjon.2021.07.031","article-title":"Radial-to-femoral pressure gradient quantification in cardiac surgery","volume":"8","author":"Kontar","year":"2021","journal-title":"JTCVS Open"},{"key":"ref_35","first-page":"326","article-title":"Selective cerebral perfusion for cerebral protection: What we do know","volume":"2","author":"Spielvogel","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"ezad047","DOI":"10.1093\/ejcts\/ezad047","article-title":"Determination of selective antegrade perfusion flow rate in aortic arch surgery to restore baseline cerebral near-infrared spectroscopy values: A single-centre observational study","volume":"63","author":"Friess","year":"2023","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_37","first-page":"1","article-title":"Antegrade cerebral perfusion: A review of its current application","volume":"29","year":"2021","journal-title":"Turk. J. Thorac. Cardiovasc. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.ejcts.2010.03.016","article-title":"Aortic arch surgery using bilateral antegrade selective cerebral perfusion in combination with near-infrared spectroscopy","volume":"38","author":"Harrer","year":"2010","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1093\/ejcts\/ezw146","article-title":"Low-flow lower body perfusion for spinal protection in a frozen elephant trunk simulation model","volume":"50","author":"Haldenwang","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1213\/ANE.0000000000004127","article-title":"Remote Ischemic Preconditioning Prevents Postoperative Acute Kidney Injury After Open Total Aortic Arch Replacement: A Double-Blind, Randomized, Sham-Controlled Trial","volume":"129","author":"Zhou","year":"2019","journal-title":"Anesth. Analg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1111\/vaa.12299","article-title":"Therapeutic hypothermia applicable to cardiac surgery","volume":"42","author":"Otto","year":"2015","journal-title":"Vet. Anaesth. Analg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S0167-5273(96)02854-9","article-title":"Reperfusion injury: A review of the pathophysiology, clinical manifestations and therapeutic options","volume":"58","author":"Maxwell","year":"1997","journal-title":"Int. J. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Alsadder, L., and Hamadah, A. (2025). Cardiac Ischaemia-Reperfusion Injury: Pathophysiology, Therapeutic Targets and Future Interventions. Biomedicines, 13.","DOI":"10.3390\/biomedicines13092084"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1051\/ject\/201547145","article-title":"The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass--Temperature Management during Cardiopulmonary Bypass","volume":"47","author":"Engelman","year":"2015","journal-title":"J. Extra Corpor. Technol."},{"key":"ref_45","first-page":"ivac282","article-title":"Temperature analysis of aortic repair with hypothermic circulatory arrest to quantify the injury by cooling","volume":"36","author":"Sato","year":"2023","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.athoracsur.2018.12.029","article-title":"Temperature Selection in Antegrade Cerebral Perfusion for Aortic Arch Surgery: A Meta-Analysis","volume":"108","author":"Tian","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1016\/S0003-4975(99)00441-5","article-title":"Cerebral metabolic suppression during hypothermic circulatory arrest in humans","volume":"67","author":"McCullough","year":"1999","journal-title":"Ann. Thorac. Surg."},{"key":"ref_48","first-page":"163","article-title":"Consensus on hypothermia in aortic arch surgery","volume":"2","author":"Yan","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1053\/j.jvca.2020.11.035","article-title":"Brain Protection in Aortic Arch Surgery: An Evolving Field","volume":"35","author":"Qu","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"816","DOI":"10.2741\/2104","article-title":"Therapeutic hypothermia: Neuroprotective mechanisms","volume":"12","author":"Liu","year":"2007","journal-title":"Front. Biosci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/ejcts\/ezt154","article-title":"Modern temperature management in aortic arch surgery: The dilemma of moderate hypothermia","volume":"45","author":"Luehr","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Goco\u0142, R., Hudziak, D., Bis, J., Mendrala, K., Morkisz, \u0141., Podsiad\u0142o, P., Kosi\u0144ski, S., Pi\u0105tek, J., and Darocha, T. (2021). The Role of Deep Hypothermia in Cardiac Surgery. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18137061"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1007\/s12055-021-01212-2","article-title":"Optimal brain protection in aortic arch surgery","volume":"38","author":"Patel","year":"2022","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1007\/s11748-020-01399-y","article-title":"Hypothermic circulatory arrest induced coagulopathy: Rotational thromboelastometry analysis","volume":"68","author":"Ise","year":"2020","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_55","first-page":"288","article-title":"Aortic arch surgery using moderate hypothermia and unilateral selective antegrade cerebral perfusion","volume":"2","author":"Leshnower","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Werner, P., Winter, M., Mahr, S., Stelzmueller, M.E., Zimpfer, D., and Ehrlich, M. (2024). Cerebral Protection Strategies in Aortic Arch Surgery-Past Developments, Current Evidence, and Future Innovation. Bioengineering, 11.","DOI":"10.3390\/bioengineering11080775"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"369","DOI":"10.21037\/acs-2025-evet-0147","article-title":"Warming up the frozen elephant trunk for aortic arch pathology","volume":"14","author":"Besola","year":"2025","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Shen, K., Tan, L., Tang, H., Zhou, X., Xiao, J., Xie, D., Li, J., and Chen, Y. (2022). Total Arch Replacement with Frozen Elephant Trunk Using a NEW \u201cBrain-Heart-First\u201d Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (\u226530 \u00b0C) with Satisfactory Outcomes. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.806822"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Li, Z., Tang, H., Deng, C., Shen, K., Li, J., Tian, S., Zhan, W., and Tan, L. (2025). Impact of mild hypothermic circulatory arrest on surgical outcomes in acute type a aortic dissection patients: A single-centre study. BMC Cardiovasc. Disord., 25.","DOI":"10.1186\/s12872-024-04443-4"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"291","DOI":"10.21037\/acs-2025-evet-0042","article-title":"Frozen elephant trunk in normothermia without circulatory arrest: Initial experience","volume":"14","author":"Berretta","year":"2025","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"ezae459","DOI":"10.1093\/ejcts\/ezae459","article-title":"Safety of prolonged bilateral antegrade cerebral perfusion in aortic arch surgery with moderate hypothermia","volume":"67","author":"Hohri","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Llerena-Velastegui, J., Velastegui-Zurita, S., Zumbana-Podaneva, K., Mejia-Mora, M., Jesus, A.C.F.S., and Coelho, P.M. (2024). Optimization of Hypothermic Protocols for Neurocognitive Preservation in Aortic Arch Surgery: A Literature Review. J. Cardiovasc. Dev. Dis., 11.","DOI":"10.3390\/jcdd11080238"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1186\/s13019-023-02448-2","article-title":"Early outcome of simplified total arch reconstruction under mild hypothermia (30\u201332 \u00b0C) with distal aortic perfusion","volume":"18","author":"Zheng","year":"2023","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1055\/s-0041-1725073","article-title":"Reoperative Aortic Arch Surgery under Mild Systemic Hypothermia: Two-Center Experience","volume":"9","author":"Risteski","year":"2021","journal-title":"Aorta"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"S799","DOI":"10.1016\/j.athoracsur.2006.11.018","article-title":"Cerebral perfusion","volume":"83","author":"Harrington","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1097\/01.mat.0000178209.89229.7b","article-title":"Effect of hypothermic cardiopulmonary bypass on blood viscoelasticity in pediatric cardiac patients","volume":"51","author":"Undar","year":"2005","journal-title":"ASAIO J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/j.1540-8191.1995.tb00681.x","article-title":"The management of temperature during cardiopulmonary bypass: Effect on neuropsychological outcome","volume":"10","author":"Nathan","year":"1995","journal-title":"J. Card. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.ejcts.2004.12.013","article-title":"Antioxidant defence during cardiopulmonary bypass surgery","volume":"27","author":"Luyten","year":"2005","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1177\/039139880102400106","article-title":"Regulation of perfusion pressure during cardiopulmonary bypass using sevoflurane","volume":"24","author":"Ueda","year":"2001","journal-title":"Int. J. Artif. Organs"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1007\/s00134-019-05761-4","article-title":"Hyperoxia during cardiopulmonary bypass does not decrease cardiovascular complications following cardiac surgery: The CARDIOX randomized clinical trial","volume":"45","author":"Huette","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1016\/j.jtcvs.2018.03.011","article-title":"Alpha-stat versus pH stat acid base balance for aortic arch surgery: The debate continues","volume":"156","author":"Kouchoukos","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_72","first-page":"e87279","article-title":"Comparison of Clinical Outcomes Between Alpha-Stat and pH-Stat Strategies During Hypothermic Circulatory Arrest: A Systematic Review","volume":"17","author":"Chatzopoulou","year":"2025","journal-title":"Cureus"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Myers, A., Nita, C., and Martinez, G. (2025). Cerebral and Spinal Cord Protection Strategies in Aortic Arch Surgery. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12040130"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Montisci, A., Maj, G., Cavozza, C., Audo, A., Benussi, S., Rosati, F., Cattaneo, S., Di Bacco, L., and Pappalardo, F. (2023). Cerebral Perfusion and Neuromonitoring during Complex Aortic Arch Surgery: A Narrative Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12103470"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1177\/02184923211028782","article-title":"Early outcome and mid-term survival after open arch repair using selective antegrade cerebral perfusion","volume":"30","author":"Berardi","year":"2022","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1272\/jnms.JNMS.2023_90-103","article-title":"Neuroprotection during Open Aortic Arch Surgery: Cerebral Perfusion Methods and Temperature","volume":"90","author":"Bessho","year":"2023","journal-title":"J. Nippon. Med. Sch."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.xjon.2022.05.006","article-title":"Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissection","volume":"11","author":"Song","year":"2022","journal-title":"JTCVS Open"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1016\/j.hlc.2025.03.018","article-title":"Unilateral Versus Bilateral Antegrade Cerebral Perfusion in Aortic Arch Surgery: Systematic Review and Meta-Analysis of Randomised Controlled Trials and Propensity-Matched Studies","volume":"34","author":"Santos","year":"2025","journal-title":"Heart Lung Circ."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"112459","DOI":"10.1016\/j.jbiomech.2024.112459","article-title":"Non-invasive assessment of cerebral perfusion pressure: Applied towards preoperative planning of aortic arch surgery with selective antegrade cerebral perfusion","volume":"179","author":"Eklund","year":"2025","journal-title":"J. Biomech."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Pitts, L., Kofler, M., Montagner, M., Heck, R., Iske, J., Buz, S., Kurz, S.D., Starck, C., Falk, V., and Kempfert, J. (2023). Cerebral Protection Strategies and Stroke in Surgery for Acute Type A Aortic Dissection. J. Clin. Med., 12.","DOI":"10.3390\/jcm12062271"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1177\/0267659112464382","article-title":"Effect of the adjunct of carbon dioxide during cardiopulmonary bypass on cerebral oxygenation","volume":"28","author":"Quarti","year":"2013","journal-title":"Perfusion"},{"key":"ref_82","first-page":"mmcts.2010.004457","article-title":"Cerebral protection during surgery of the aortic arch","volume":"2011","author":"Pilato","year":"2011","journal-title":"Multimed. Man. Cardiothorac. Surg."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/MAT.0b013e318241abd3","article-title":"Real-time continuous neuromonitoring combines transcranial cerebral Doppler with near-infrared spectroscopy cerebral oxygen saturation during total aortic arch replacement procedure: A pilot study","volume":"58","author":"Wang","year":"2012","journal-title":"ASAIO J."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3390\/anesthres1020010","article-title":"Enhancing Neuroprotection in Cardiac and Aortic Surgeries: A Narrative Review","volume":"1","author":"Torre","year":"2024","journal-title":"Anesth. Res."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1016\/j.jtcvs.2021.07.025","article-title":"Intraoperative neurophysiologic monitoring during aortic arch surgery","volume":"165","author":"Sultan","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/S0003-4975(00)01592-7","article-title":"Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials","volume":"71","author":"Stecker","year":"2001","journal-title":"Ann. Thorac. Surg."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1177\/1089253216672441","article-title":"Neurophysiological Intraoperative Monitoring During Aortic Arch Surgery","volume":"20","author":"Keenan","year":"2016","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"597","DOI":"10.2459\/JCM.0b013e328356a485","article-title":"Usefulness of transcranial color Doppler ultrasonography in aortic arch surgery","volume":"14","author":"Catena","year":"2013","journal-title":"J. Cardiovasc. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/1476-7120-4-47","article-title":"Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: The role of transcranial Doppler\u2014A systematic review of the literature","volume":"4","author":"Polito","year":"2006","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/S1010-7940(01)00981-2","article-title":"Cerebral embolisation during modern cardiopulmonary bypass","volume":"20","author":"Fearn","year":"2001","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1093\/bja\/aeg234","article-title":"Neurologic Outcome Research Group (NORG). Cerebral embolization during cardiac surgery: Impact of aortic atheroma burden","volume":"91","author":"Mackensen","year":"2003","journal-title":"Br. J. Anaesth."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1093\/ejcts\/ezw325","article-title":"Cannulation of an arch artery for hostile aorta","volume":"51","author":"Urbanski","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/j.1399-6576.2011.02563.x","article-title":"Transcranial Doppler microembolic signals and serum marker evidence of brain injury during transcatheter aortic valve implantation","volume":"56","author":"Reinsfelt","year":"2012","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/0003-4975(91)90793-P","article-title":"When do cerebral emboli appear during open heart operations? A transcranial Doppler study","volume":"51","year":"1991","journal-title":"Ann. Thorac. Surg."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.1093\/ejcts\/ezt043","article-title":"Antegrade and retrograde arterial perfusion strategy in minimally invasive mitral-valve surgery: A propensity score analysis on 1280 patients","volume":"43","author":"Murzi","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.athoracsur.2007.08.047","article-title":"Carbon dioxide field flooding reduces neurologic impairment after open heart surgery","volume":"85","author":"Martens","year":"2008","journal-title":"Ann. Thorac. Surg."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1051\/ject\/200739296","article-title":"Pharmacologic neuroprotection: The search continues","volume":"39","author":"Grocott","year":"2007","journal-title":"J. Extra Corpor. Technol."},{"key":"ref_98","first-page":"1520","article-title":"Propofol: An anesthetic possessing neuroprotective effects","volume":"19","author":"Fan","year":"2015","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/ACO.0000000000000212","article-title":"Update on anesthetic neuroprotection","volume":"28","author":"Zwerus","year":"2015","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Motshabi-Chakane, P., Mogane, P., Moutlana, J., Leballo-Mothibi, G., Dingezweni, S., Mpanya, D., and Tsabedze, N. (2021). Contemporary Neuroprotection Strategies during Cardiac Surgery: State of the Art Review. Int. J. Environ. Res. Public Health., 18.","DOI":"10.3390\/ijerph182312747"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1093\/ejcts\/ezt665","article-title":"Visceral organ protection in aortic arch surgery: Safety of moderate hypothermia","volume":"46","author":"Pacini","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1093\/ejcts\/ezu243","article-title":"Multiple factors predict the risk of spinal cord injury after the frozen elephant trunk technique for extended thoracic aortic disease","volume":"47","author":"Katayama","year":"2015","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1053\/j.semtcvs.2017.05.007","article-title":"Fluctuations in Spinal Cord Perfusion Pressure: A Harbinger of Delayed Paraplegia After Thoracoabdominal Aortic Repair","volume":"29","author":"Sandhu","year":"2017","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1055\/s-0042-1756669","article-title":"Spinal Cord Ischemia in Open and Endovascular Aortic Repair","volume":"10","author":"Rinaldi","year":"2022","journal-title":"Aorta"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1213\/ANE.0b013e31824d2723","article-title":"Acute normovolemic hemodilution can aggravate neurological injury after spinal cord ischemia in rats","volume":"114","author":"Kim","year":"2012","journal-title":"Anesth. Analg."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"rjab174","DOI":"10.1093\/jscr\/rjab174","article-title":"Spinal cord monitoring using collateral network near-infrared spectroscopy during extended aortic arch surgery with a frozen elephant trunk","volume":"2021","author":"Sgouropoulou","year":"2021","journal-title":"J. Surg. Case Rep."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s12055-021-01288-w","article-title":"Early awaking of patients following FET allows early recognition of paraplegia with prospects for complete recovery using prompt spinal drainage","volume":"38","author":"Vendramin","year":"2022","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1016\/j.athoracsur.2022.05.021","article-title":"Impact of Recovery from Acute Kidney Injury After Aortic Arch Repair","volume":"116","author":"Nishio","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.athoracsur.2018.08.085","article-title":"Impact of Cardiopulmonary Bypass Flow on Renal Oxygenation in Patients Undergoing Cardiac Operations","volume":"107","author":"Lannemyr","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.athoracsur.2015.02.034","article-title":"Surgical and Clinical Outcome REsearch (SCORE) Group. Acute Kidney Injury and Hemodilution During Cardiopulmonary Bypass: A Changing Scenario","volume":"100","author":"Ranucci","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s00134-021-06401-6","article-title":"Restrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): A pilot randomized controlled feasibility trial","volume":"47","author":"Vaara","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"R154","DOI":"10.1186\/cc7145","article-title":"Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients","volume":"12","author":"Lecomte","year":"2008","journal-title":"Crit. Care"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.2215\/CJN.11290821","article-title":"Drug-Induced Acute Kidney Injury","volume":"17","author":"Perazella","year":"2022","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s12055-018-0757-5","article-title":"Review: Perspectives on renal and visceral protection during thoracoabdominal aortic aneurysm repair","volume":"35","author":"Whitlock","year":"2019","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jvs.2011.11.126","article-title":"The impact of selective visceral perfusion on intestinal macrohemodynamics and microhemodynamics in a porcine model of thoracic aortic cross-clamping","volume":"56","author":"Kalder","year":"2012","journal-title":"J. Vasc. Surg."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.ejvs.2018.08.055","article-title":"Volume Based Resuscitation and Intestinal Microcirculation after Ischaemia\/Reperfusion Injury: Results of an Exploratory Aortic Clamping Study in Pigs","volume":"57","author":"Behem","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1007\/s00068-007-7152-z","article-title":"Ischemia-Reperfusion Injury: Pathophysiology and Clinical Implications","volume":"33","author":"Dorweiler","year":"2007","journal-title":"Eur. J. Trauma. Emerg. Surg."},{"key":"ref_118","first-page":"310","article-title":"Peripheral arterial blood pressure versus central crterial blood pressure monitoring in critically ill patients after Cardio-pulmonary Bypass","volume":"33","author":"Ahmad","year":"2017","journal-title":"Pak. J. Med. Sci."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1053\/j.jvca.2004.01.023","article-title":"Deep hypothermic circulatory arrest and the femoral-to-radial arterial pressure gradient","volume":"18","author":"Manecke","year":"2004","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1177\/0391398818784791","article-title":"Pressure difference between radial and femoral artery pressure in minimally invasive cardiac surgery using retrograde perfusion","volume":"41","author":"Nakamura","year":"2018","journal-title":"Int. J. Artif. Organs."},{"key":"ref_121","first-page":"23","article-title":"Body perfusion in surgery of the aortic arch","volume":"34","author":"Nappi","year":"2007","journal-title":"Tex. Heart Inst. J."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/1749-8090-9-94","article-title":"Right axillary and femoral artery perfusion with mild hypothermia for aortic arch replacement","volume":"9","author":"Guo","year":"2014","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s00101-021-00983-y","article-title":"Extended neuromonitoring in aortic arch surgery: A case series","volume":"70","author":"Thudium","year":"2021","journal-title":"Anaesthesist"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"13541","DOI":"10.1038\/s41598-023-40615-6","article-title":"Association of pulmonary artery catheter with in-hospital outcomes after cardiac surgery in the United States: National Inpatient Sample 1999\u20132019","volume":"13","author":"Beydoun","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"4859","DOI":"10.21037\/jtd-23-561","article-title":"Nadir oxygen delivery during cardiopulmonary bypass in acute type A aortic dissection repair","volume":"15","author":"Peng","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_126","doi-asserted-by":"crossref","unstructured":"Wang, D., Yang, C., Wang, H., Ye, M., Xue, C., Wang, W., Yu, B., Ren, K., Jin, Z., and Yu, S. (2025). High perioperative lactate levels as a potential predictor for severe acute kidney injury following aortic arch surgery. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1495502"},{"key":"ref_127","doi-asserted-by":"crossref","unstructured":"Lyu, Y., Liu, Y., Xiao, X., Yang, Z., Ge, Y., and Jiang, H. (2023). High level of intraoperative lactate might predict acute kidney injury in aortic arch surgery via minimally invasive approach in patients with type A dissection. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1188393"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.echo.2025.03.017","article-title":"Intraoperative Transesophageal Echocardiography in Acute Type A Aortic Dissection: Contemporary Approach","volume":"38","author":"Kelava","year":"2025","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1053\/j.jvca.2021.02.048","article-title":"Volatile and Intravenous Anesthetics for Brain Protection in Cardiac Surgery: Does the Choice of Anesthesia Matter?","volume":"36","author":"Lomivorotov","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"3758","DOI":"10.1053\/j.jvca.2022.06.014","article-title":"Effect of Volatile Anesthesia Versus Total Intravenous Anesthesia on Postoperative Pulmonary Complications in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial","volume":"36","author":"He","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1056\/NEJMoa1816476","article-title":"Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery","volume":"380","author":"Landoni","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.athoracsur.2015.08.002","article-title":"Electroencephalography During Hemiarch Replacement with Moderate Hypothermic Circulatory Arrest","volume":"101","author":"Keenan","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/2045-9912-2-22","article-title":"The role of Volatile Anesthetics in Cardioprotection: A systematic review","volume":"2","author":"Krafft","year":"2012","journal-title":"Med. Gas Res."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"2192","DOI":"10.1177\/0271678X18789273","article-title":"Effects of anesthesia on cerebral blood flow, metabolism, and neuroprotection","volume":"38","author":"Slupe","year":"2018","journal-title":"J. Cereb. Blood Flow. Metab."},{"key":"ref_135","doi-asserted-by":"crossref","unstructured":"Ltaief, Z., Ben-Hamouda, N., Rancati, V., Gunga, Z., Marcucci, C., Kirsch, M., and Liaudet, L. (2022). Vasoplegic Syndrome after Cardiopulmonary Bypass in Cardiovascular Surgery: Pathophysiology and Management in Critical Care. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216407"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"3749","DOI":"10.1111\/jocs.15805","article-title":"Vasoplegic syndrome after cardiovascular surgery: A review of pathophysiology and outcome-oriented therapeutic management","volume":"36","author":"Datt","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s13054-023-04446-1","article-title":"Initiating angiotensin II at lower vasopressor doses in vasodilatory shock: An exploratory post-hoc analysis of the ATHOS-3 clinical trial","volume":"27","author":"Wieruszewski","year":"2023","journal-title":"Crit. Care"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s13019-017-0613-5","article-title":"Consumption coagulopathy in acute aortic dissection: Principles of management","volume":"12","author":"Liu","year":"2017","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Erdoes, G., Ahmed, A., Kurz, S.D., Gerber, D., and Bolliger, D. (2023). Perioperative hemostatic management of patients with type A aortic dissection. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1294505"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1093\/bja\/aex100","article-title":"Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: Updated systematic review and meta-analysis","volume":"118","author":"Serraino","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.athoracsur.2016.01.005","article-title":"Fibrinogen Levels After Cardiac Surgical Procedures: Association with Postoperative Bleeding, Trigger Values, and Target Values","volume":"102","author":"Ranucci","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1055\/s-0039-3402759","article-title":"Fibrinogen Concentrate to Cardiac Surgery Patients with Ongoing Bleeding does not Increase the Risk of Thromboembolic Complications or Death","volume":"120","author":"Jeppsson","year":"2020","journal-title":"Thromb. Haemost."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1161\/CIRCULATIONAHA.116.023956","article-title":"Point-of-Care Hemostatic Testing in Cardiac Surgery: A Stepped-Wedge Clustered Randomized Controlled Trial","volume":"134","author":"Karkouti","year":"2016","journal-title":"Circulation"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1213\/ANE.0000000000000054","article-title":"Platelet dysfunction as measured by a point-of-care monitor is an independent predictor of high blood loss in cardiac surgery","volume":"118","author":"Orlov","year":"2014","journal-title":"Anesth. Analg."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s11239-024-03061-3","article-title":"Thrombin generation after prothrombin complex concentrate or plasma transfusion during cardiac surgery","volume":"58","author":"Welsby","year":"2025","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1111\/jth.15195","article-title":"Managing the coagulopathy associated with cardiopulmonary bypass","volume":"19","author":"Bartoszko","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_147","doi-asserted-by":"crossref","unstructured":"Chung, J., Kim, I.J., Ju, J.W., Hong, C.H., Cho, Y.J., Jeon, Y., and Nam, K. (2025). Effectiveness and safety of low-dose intraoperative tranexamic acid in cardiac surgery: A retrospective before-and-after study. BMC Anesthesiol., 25.","DOI":"10.1186\/s12871-025-03423-1"},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"120","DOI":"10.31083\/j.rcm2404120","article-title":"Evidence in Cardiovascular Anesthesia (EICA) Group. Intravenous Tranexamic Acid Reduces Post-Operative Bleeding and Blood Transfusion in Patients Undergoing Aortic Surgery: A PRISMA-Compliant Systematic Review and Meta-Analysis","volume":"24","author":"Zhang","year":"2023","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/EJA.0000000000001632","article-title":"Efficacy and safety of aprotinin in paediatric cardiac surgery: A systematic review and meta-analysis","volume":"39","author":"Atasever","year":"2022","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1002\/rth2.12024","article-title":"Near-patient coagulation testing to predict bleeding after cardiac surgery: A cohort study","volume":"1","author":"Mumford","year":"2017","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"100031","DOI":"10.1016\/j.rpth.2022.100031","article-title":"Viscoelastic testing: An illustrated review of technology and clinical applications","volume":"7","author":"Hartmann","year":"2022","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1177\/0267659113479816","article-title":"Blood conservation strategies reduce the need for transfusions in ascending and aortic arch surgery","volume":"28","author":"Chu","year":"2013","journal-title":"Perfusion"},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1093\/icvts\/ivz014","article-title":"Retrograde autologous priming in surgery of thoracic aortic aneurysm","volume":"28","author":"Williams","year":"2019","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.jtcvs.2020.06.005","article-title":"Extensive cell salvage and postoperative outcomes following thoracoabdominal and descending aortic repair","volume":"163","author":"Kiser","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1308\/003588413X13629960047957","article-title":"Successful surgical repair of acute type A aortic dissection without the use of blood products","volume":"95","author":"Papalexopoulou","year":"2013","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"236","DOI":"10.4097\/kja.23698","article-title":"Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: A retrospective analysis","volume":"77","author":"Lee","year":"2024","journal-title":"Korean J. Anesthesiol."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1051\/ject\/200537157","article-title":"Predicting blood usage in cardiac surgery--the transfusion predictor product","volume":"37","author":"McDonald","year":"2005","journal-title":"J. Extra Corpor. Technol."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1016\/j.athoracsur.2017.05.009","article-title":"Elective Aortic Arch Repair: Factors Influencing Neurologic Outcome in 791 Patients","volume":"104","author":"Cefarelli","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.amjsurg.2022.07.011","article-title":"Evaluating the risk of spinal cord ischemia in zone 2 frozen elephant trunk replacement","volume":"224","author":"Kemp","year":"2022","journal-title":"Am. J. Surg."},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1093\/icvts\/ivu241","article-title":"Risk factors for acute kidney injury in aortic arch surgery with selective cerebral perfusion and mild hypothermic lower body circulatory arrest","volume":"19","author":"Nota","year":"2014","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.bpa.2015.08.006","article-title":"Perioperative ventilatory strategies in cardiac surgery","volume":"29","author":"Lellouche","year":"2015","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"957","DOI":"10.23736\/S0375-9393.24.18267-3","article-title":"Recommendations for fast-track extubation in adult cardiac surgery patients: A consensus statement","volume":"90","author":"Silvetti","year":"2024","journal-title":"Minerva Anestesiol."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.ccc.2020.06.003","article-title":"Postoperative Multimodal Analgesia in Cardiac Surgery","volume":"36","author":"Barr","year":"2020","journal-title":"Crit. Care Clin."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.athoracsur.2023.12.006","article-title":"Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS)","volume":"117","author":"Grant","year":"2024","journal-title":"Ann. Thorac. Surg."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1016\/j.jtcvs.2015.01.044","article-title":"The elephant trunk is freezing: The Hannover experience","volume":"149","author":"Shrestha","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"1996","DOI":"10.1053\/j.jvca.2016.11.011","article-title":"Incidence and Risk Factors of Delirium in Patients After Type-A Aortic Dissection Surgery","volume":"31","author":"Liu","year":"2017","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s12055-023-01624-2","article-title":"Frozen elephant trunk in acute aortic dissection: A literature review","volume":"39","author":"Murana","year":"2023","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"178","DOI":"10.21037\/acs-2020-fet-25","article-title":"Results of frozen elephant trunk from the international E-vita Open registry","volume":"9","author":"Tsagakis","year":"2020","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jss.2019.03.055","article-title":"Predictors of Acute Kidney Injury Following Aortic Arch Surgery","volume":"242","author":"Ghincea","year":"2019","journal-title":"J. Surg. Res."},{"key":"ref_170","doi-asserted-by":"crossref","unstructured":"Zhang, C.H., Ge, Y.P., Zhong, Y.L., Hu, H.O., Qiao, Z.Y., Li, C.N., and Zhu, J.M. (2022). Massive Bleeding After Surgical Repair in Acute Type A Aortic Dissection Patients: Risk Factors, Outcomes, and the Predicting Model. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.892696"},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/j.athoracsur.2014.01.014","article-title":"Mortality and morbidity after total aortic arch replacement","volume":"97","author":"Tanaka","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"2754","DOI":"10.1053\/j.jvca.2019.10.038","article-title":"Monitoring of the Sublingual Microcirculation During Cardiac Surgery: Current Knowledge and Future Directions","volume":"34","author":"Flick","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/jch.14774","article-title":"A predictive model for postoperative adverse outcomes following surgical treatment of acute type A aortic dissection based on machine learning","volume":"26","author":"Xie","year":"2024","journal-title":"J. Clin. Hypertens."},{"key":"ref_174","doi-asserted-by":"crossref","unstructured":"Ayhan, C., Mekhaeil, M., Channawi, R., Ozcan, A.E., Akargul, E., Deger, A., Cayan, I., Abdalla, A., Chan, C., and Mahon, R. (2025). Applications of Artificial Intelligence as a Prognostic Tool in the Management of Acute Aortic Syndrome and Aneurysm: A Comprehensive Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14238420"},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"335","DOI":"10.21037\/acs-2025-evet-0105","article-title":"From back table innovation to contemporary application: A review of the frozen elephant trunk technique","volume":"14","author":"Weiss","year":"2025","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/15569845251347968","article-title":"State-of-the-Art Review of Aortic Arch Reconstruction with the Frozen Elephant Trunk","volume":"20","author":"Bozso","year":"2025","journal-title":"Innovations"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/877\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:44:36Z","timestamp":1769010276000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/877"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":176,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020877"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020877","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,21]]}}}