Evidence map›Paper›PMID 42237324›Full record

Observational studyJournal of cardiothoracic surgery2026

Zone 1 total arch replacement with frozen elephant trunk for type A dissection: early-to-mid-term outcomes.

Yusuke Takei, Ikuko Shibasaki, Masahiro Tezuka, Takashi Kato, Takeshi Ogasawara, Takayuki Hori, Toshiyuki Kuwata, Go Tsuchiya, Masashi Kawamura, Hirotsugu Fukuda

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

10 authors.

Yusuke TakeiDepartment of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan. y-takei@dokkyomed.ac.jp.
Ikuko ShibasakiDepartment of Cardiovascular Surgery, Iwaki City Medical Center, Iwaki, Fukushima, Japan.
Masahiro TezukaDepartment of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan.
Takashi KatoDepartment of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan.
Takeshi OgasawaraDepartment of Fundamental Education Premedical Sciences, Dokkyo Medical University, Mibu-machi, Shimotsuga-gun, Tochigi, Japan.
Takayuki HoriDepartment of Cardiovascular Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan.
Toshiyuki KuwataDepartment of Cardiovascular Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan.
Go TsuchiyaDepartment of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan.
Masashi KawamuraDepartment of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan.
Hirotsugu FukudaDepartment of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTotal arch replacement with frozen elephant trunk is widely used to treat acute Stanford type A aortic dissection. Zone 1 proximalization, which requires concomitant extra-anatomical left subclavian artery bypass, may provide a practical balance between safety and technical complexity. Although the early outcomes of this procedure have previously been reported, comprehensive mid-term data, particularly regarding left subclavian artery bypass durability, remain limited. This study aimed to evaluate the early and mid-term outcomes of zone 1 proximalization in total arch replacement with frozen elephant trunk for acute Stanford type A aortic dissection.

methodsThis retrospective observational study included 80 patients with acute type A aortic dissection who underwent zone 1 total arch replacement with frozen elephant trunk, which requires concomitant extra-anatomical left subclavian artery bypass, between 2014 and 2025 at two institutions. Primary outcomes were postoperative mortality and freedom from aorta- and left subclavian artery bypass-related events. Secondary outcomes included perioperative complications and reinterventions. Event-free survival was assessed using Kaplan-Meier analysis.

resultsThirty-day and in-hospital mortality rates were 8.8% and 10.0%, respectively. Stroke occurred in 12.5% of patients and spinal cord injury in 5.0%. Freedom from aorta-related events was 88.4%, 84.0%, and 81.5% at one, three, and five years, respectively; corresponding rates for left subclavian artery bypass-related events were 95.6%, 91.5%, and 86.4%, respectively. Of the 21 aorta-related events, 62% involved the downstream aorta and were managed with endovascular repair. The eight left subclavian artery bypass-related events were mostly asymptomatic occlusions caused by technical issues. Distal stent graft-induced new entry, a major late complication, was associated with a larger zone 4 diameter.

conclusionsThis descriptive study provided early and mid-term outcome data for zone 1 total arch replacement with frozen elephant trunk in patients with acute type A aortic dissection. The long-term durability of the left subclavian artery bypass remains a concern. Considering the anatomical features of the patient and ensuring vigilant follow-up may reduce downstream events, making this procedure a viable option for selected patients.

Indexed as

Aorta, ThoracicAortic DissectionBlood Vessel Prosthesis ImplantationDissection, Ascending AortaAgedBlood Vessel ProsthesisFemaleHospital MortalityHumansMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesSubclavian ArteryTreatment OutcomeDistal stent graft-induced new entryFrozen elephant trunkLeft subclavian arteryStanford type A aortic dissection

Identifiers

PMID42237324
PMCPMC13474498

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.