{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:40:51Z","timestamp":1760236851512,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,29]],"date-time":"2021-12-29T00:00:00Z","timestamp":1640736000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>The management of patients with aortic disease that involves the ascending aorta, the aortic arch, and the descending aorta represent a surgical challenge. Open surgical repair remains the gold standard for aortic arch pathologies. However, this operation requires a cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest, which carries a substantial rate of mortality and morbidity. For these reasons, hybrid arch repair that involves a combination of open surgery with endovascular aortic stent graft placement has been introduced as a therapeutic alternative for those patients deemed unfit for open surgical procedures. Hybrid repair requires varying degrees of invasiveness and can be performed as a single-stage procedure or as a two-stage procedure. The choice of the technique is multifactorial, depending on the characteristics of the diseased arch with regard to position of the stent graft proximal landing zone, patient fitness and comorbid status, as well as surgical expertise and hospital facilities. Among the evolving hybrid procedures is the so-called \u201cfrozen\u201d or stented elephant trunk technique. Adapted from the classical elephant trunk technique, this approach facilitates the repair of a concomitant aortic arch and proximal descending aortic aneurysms in a single stage under circulatory arrest. This technique is increasingly being used to treat extensive thoracic aortic disease and has shown promising results.<\/jats:p>","DOI":"10.3390\/medicina58010049","type":"journal-article","created":{"date-parts":[[2021,12,29]],"date-time":"2021-12-29T08:12:15Z","timestamp":1640765535000},"page":"49","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hybrid Approach in Acute and Chronic Aortic Disease"],"prefix":"10.3390","volume":"58","author":[{"given":"Michele","family":"Murzi","sequence":"first","affiliation":[{"name":"Adult Cardiac Surgery Division, Geatano Pasquinucci Heart Hospital, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pier Andrea","family":"Farneti","sequence":"additional","affiliation":[{"name":"Adult Cardiac Surgery Division, Geatano Pasquinucci Heart Hospital, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Rizza","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Division, Geatano Pasquinucci Heart Hospital, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Di Sibio","sequence":"additional","affiliation":[{"name":"Adult Cardiac Surgery Division, Geatano Pasquinucci Heart Hospital, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cataldo","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Division, Geatano Pasquinucci Heart Hospital, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Solinas","sequence":"additional","affiliation":[{"name":"Adult Cardiac Surgery Division, Geatano Pasquinucci Heart Hospital, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1093\/ejcts\/ezx133","article-title":"Hypothermia and cerebral protection strategies in aortic arch surgery: A comparative effec-tiveness analysis from the STS Adult Cardiac Surgery Database","volume":"52","author":"Englum","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2661","DOI":"10.1161\/CIRCULATIONAHA.111.033944","article-title":"Survival After Open Versus Endovascular Thoracic Aortic Aneurysm Repair in an Observational Study of the Medicare Population","volume":"124","author":"Goodney","year":"2011","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1053\/j.semtcvs.2009.11.007","article-title":"Hybrid Repair of Aortic Arch Aneurysms: Combined Open Arch Reconstruction and Endovascular Repair","volume":"21","author":"Szeto","year":"2009","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S77","DOI":"10.1016\/j.jtcvs.2010.07.031","article-title":"Classic hybrid evolving approach to distal arch aneurysms: Toward the zone zero solution","volume":"140","author":"Bavaria","year":"2010","journal-title":"J. Thorac. Cardiovasc. 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Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1093\/icvts\/ivw305","article-title":"Meta-analysis of open surgical repair versus hybrid arch repair for aortic arch aneurysm","volume":"24","author":"Miao","year":"2016","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/ejcts\/ezv063","article-title":"Hybrid versus open repair of aortic arch aneurysms: Comparison of postoperative and mid-term outcomes with a propensity score-matching analysis","volume":"49","author":"Tokuda","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.jtcvs.2012.09.011","article-title":"Current results of open total arch replacement versus hybrid thoracic endovascular aortic repair for aortic arch aneurysm: A meta-analysis of comparative studies","volume":"145","author":"Benedetto","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"91S","DOI":"10.1016\/j.jvs.2010.06.149","article-title":"Endoleak management and postoperative surveillance following endovascular repair of thoracic aortic aneurysms","volume":"52","author":"Ricotta","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1583\/08-2551.1","article-title":"Endoleaks Following Endovascular Repair of Thoracic Aortic Aneurysm: Etiology and Outcomes","volume":"15","author":"Morales","year":"2008","journal-title":"J. Endovasc. 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Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1093\/ejcts\/ezt493","article-title":"Antegrade stenting of the descending thoracic aorta during DeBakey type 1 acute aortic dissection repair","volume":"45","author":"Castrovinci","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1093\/ejcts\/ezx131","article-title":"Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: Results from an international multicentre registry","volume":"52","author":"Iafrancesco","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1093\/ejcts\/ezy031","article-title":"True-lumen and false-lumen diameter changes in the downstream aorta after frozen elephant trunk implantation","volume":"54","author":"Berger","year":"2018","journal-title":"Eur. J. Cardiothorac. 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