Search Results (162)

Objectives: This study aimed to evaluate the impact of thoracic endovascular aortic repair (TEVAR) on aortic remodeling using CT angiography-based morphometric measurements and to examine associated mid-term clinical outcomes in patients with acute Stanford type B aortic dissection. Methods: This retrospective, single-center observational cohort study included 33 consecutive patients who underwent TEVAR for acute Stanford type B aortic dissection between January 2020 and January 2025. Preoperative and postoperative true lumen (TL), false lumen (FL), and descending aorta (DA) diameters were compared using paired t-tests after Shapiro–Wilk normality testing. Endoleak, reintervention, FL thrombosis, and mortality were analyzed. Univariable analyses identified factors associated with endoleak and reintervention. Spearman’s correlation assessed factors associated with morphometric remodeling response. Results: All 33 patients had acute Stanford type B dissection (mean time to intervention: 2.73 ± 3.86 days). Among 33 patients (81.8% male; mean age 53.6 ± 12.1 years), mean follow-up was 4.08 ± 1.66 years. TEVAR induced a significant aortic remodeling response: TL diameter increased from 9.55 ± 5.91 mm to 28.30 ± 5.49 mm (+18.76 ± 8.83 mm; p < 0.001) and FL diameter decreased from 33.39 ± 6.76 mm to 11.48 ± 8.97 mm (−21.91 ± 9.53 mm; p < 0.001), while DA diameter remained stable (42.94 ± 6.90 vs. 42.03 ± 9.46 mm; p = 0.323). Complete FL thrombosis was achieved in 19 patients (57.6%). Endoleak occurred in nine patients (27.3%); Zone 2 landing was significantly associated with endoleak (54.5% vs. 13.6%, p = 0.033). Secondary intervention was required in 13 patients (39.4%). Overall mortality was 12.1%. Narrower preoperative TL was strongly associated with greater TL expansion (Spearman r = −0.724, p < 0.001); longer stent–graft coverage was associated with greater TL gain (r = +0.522, p = 0.002). Conclusions: TEVAR induced clinically meaningful aortic remodeling in acute Stanford type B dissection without progressive aortic enlargement. A narrower baseline TL and longer stent–graft coverage were associated with greater remodeling benefit. Zone 2 deployment was significantly associated with higher endoleak rates, underscoring the value of careful preprocedural planning and systematic long-term imaging surveillance. Full article

Aims: Globally, cardiovascular disorders represent the foremost contributor to mortality, and elevated arterial pressure constitutes one of their principal risk determinants. Despite the availability of various treatments, optimal blood pressure control is rarely achieved. The present work was undertaken to assess the antihypertensive and vasorelaxant properties of benzaldehyde, a naturally occurring aromatic aldehyde whose role in the regulation of arterial pressure has, to our knowledge, not yet been documented. Materials and Methods: Antihypertensive activity was evaluated in normotensive Wistar rats and in animals rendered hypertensive by chronic administration of Nω-nitro-L-arginine methyl ester (L-NAME). Benzaldehyde was administered orally at doses of 20 and 40 mg/kg under both acute (6 h) and subacute (7-day) treatment protocols. Arterial pressure was recorded non-invasively by means of a tail-cuff plethysmography system. Vasorelaxant activity was examined in vitro using isolated rat aortic rings precontracted with either Epinephrine (EP, 10 μM) or potassium chloride (KCl, 80 mM). Endothelium-dependent and endothelium-independent components were dissected by pre-incubating the rings with selective pharmacological inhibitors. Additionally, the effects of benzaldehyde on both phasic and tonic contractions induced by extracellular Ca²⁺ were assessed in EP-precontracted rings in Ca²⁺-free Krebs solution. Key Findings: In hypertensive animals, benzaldehyde produced a dose-related decrease in both systolic and diastolic arterial pressure. It induced concentration-dependent vasorelaxation in both endothelium-intact and -denuded aortic rings. Relaxation was also observed in KCl-precontracted rings. Vasorelaxant responses were significantly attenuated by Indomethacin, Nifedipine, and 2-Aminoethoxydiphenyl borinate (2-APB). Significance: These findings demonstrate that benzaldehyde lowers blood pressure through both endothelium-dependent and -independent mechanisms. These include activation of the prostacyclin (PGI₂)/cAMP pathway, inhibition of L-type calcium channels, and blockade of store-operated calcium channels (SOCCs). Full article

Acute kidney injury (AKI) caused by ischemia–reperfusion injury (IRI) involves rapid activation of innate immune responses, in which myeloid-derived immune cells critically shape injury severity. Y-box binding protein 1 (YB-1) regulates pro-inflammatory gene expression intracellularly and can be secreted to function extracellularly, yet how these two compartments jointly influence early IRI pathology remains poorly understood. To dissect the roles of intracellular myeloid versus extracellular YB-1, we subjected myeloid-specific Ybx1 knockout, Ybx1^fl/fl × LysM^cre, mice and wild-type (WT) littermates to unilateral renal IRI following administration of either a neutralizing anti-YB-1 antibody or control IgG. Kidney injury, inflammation, immune cell recruitment, neutrophil extracellular trap (NET) formation, antibody localization, and Fcγ receptor expression were assessed by qRT-PCR, histology, immunostaining, Western blotting, and flow cytometry. Myeloid-specific knockout of Ybx1 markedly reduced renal inflammation, neutrophil infiltration, NET formation, and tubular injury. This protective phenotype was lost when extracellular YB-1 was simultaneously reduced: anti-YB-1 treatment in knockout mice restored pro-inflammatory cytokine expression, increased tubular damage markers such as NGAL and KIM-1, exacerbated neutrophil recruitment and NET formation, and led to luminar accumulation of YB-1/anti-YB-1 immune complexes in tubular cells. Mechanistically, Ybx1-deficient myeloid cells exhibited significantly reduced CD16 expression, pointing to impaired Fcγ receptor-mediated phagocytosis as the cause of defective immune complex clearance. In contrast, wild-type mice efficiently cleared extracellular YB-1 complexes and showed no injury aggravation upon antibody treatment. Our findings identify myeloid YB-1 as a central regulator of early inflammatory injury in renal IRI and reveal that its protective depletion becomes pathogenic when extracellular YB-1 is simultaneously neutralized, likely due to unmasked defects in immune complex clearance. Full article

Background: The nature and prognosis of type A intramural hematoma (TAIMH) are not well established. In this study, we evaluated the early and late outcome after surgery for this emergency condition. Methods: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) or TAIMH at 18 European centers for cardiac surgery. In this study, we compared the early and late outcomes of TAIMH and typical TAAD. Results: In total, 3902 consecutive patients were included in the ERTAAD registry, and 386 (9.9%) patients had TAIMH. Penn class a was present in 43.1% TAAD patients and in 34.5% TAIMH patients (p < 0.001). Among 3-month survivors, 10-year relative survival was 0.80 (95%CI 0.77–0.84) in TAAD patients and 0.76 (95%CI 0.63–0.88) in TAIMH patients. Propensity-score matching yielded 386 pairs of patients, and no significant difference was observed between the study groups in terms of early and late outcomes. In-hospital mortality rates were comparable (TAIMH 13.5% vs. TAAD 16.3%, p = 0.266). Ten-year mortality was 51.3% among TAIMH patients and 51.6% among TAAD patients (p = 0.274). TAIMH and TAAD had similar 10-year cumulative incidence rates of proximal (4.2% vs. 3.3%, p = 0.738) and distal aortic reoperations (12.6% vs. 7.6%, p = 0.779). Conclusions: This cohort study showed that the prevalence of patients with TAIMH requiring surgery is low and their risk profile is significantly different as shown by the Penn classification. The early and late outcomes of the study groups were not statistically different compared to typical TAAD when adjusted for baseline and operative variables. The relative survivals of 90-day TAIMH and TAAD survivors were low compared to the matched general population, indicating that surgically treated TAIMH demonstrated postoperative outcomes are poor and comparable to surgically treated TAAD after adjustment. Post-hoc power analysis suggested that much larger studies are needed to confirm these findings. These results are limited to TAIMH patients who underwent surgery, and this study did not address the outcome of patients who were conservatively treated. Full article

Objectives: Perioperative blood transfusion for acute type A aortic dissection (ATAAD) lacks clinical guidelines. This study aims to investigate the application of a thromboelastography (TEG)-based risk-stratified transfusion protocol in these patients. Methods: We conducted a two-stage study. Firstly, a retrospective analysis of ATAAD patients undergoing surgery in 2023 was performed to identify predictors of postoperative/perioperative excessive bleeding and develop a predictive model. Subsequently, a single-center prospective validation study was conducted in 2024, comparing a TEG-based risk-stratified transfusion protocol against conventional empirical transfusion. Results: In the retrospective phase (n = 57), 18 patients (31.6%) developed perioperative excessive bleeding. Preoperative activated clotting time (ACT) and TEG parameters (K-time) were independent predictors. A predictive model incorporating these variables achieved an AUC of 0.788. In the prospective phase (n = 47), 21 patients received the TEG-based risk-stratified transfusion protocol. Compared to the conventional group, the TEG risk-stratified group exhibited significantly lower postoperative drainage volume (p = 0.046), a reduced incidence of perioperative excessive bleeding (4.8% vs. 34.6%, p = 0.033), and lower transfusion costs (p = 0.029), without an increase in total transfusion volume. Conclusions: Preoperative ACT and TEG parameters effectively predict perioperative excessive bleeding in ATAAD patients. Implementing a TEG-based risk-stratified transfusion protocol optimizes blood product utilization, improves clinical outcomes, and reduces costs, offering a promising evidence-based approach for perioperative management. Full article

Background: Acute type A aortic dissection (ATAAD) is a life-threatening condition that may be complicated by malperfusion, particularly in patients with prior aortic interventions such as Thoracic Endovascular Aortic Repair (TEVAR). Management becomes increasingly complex when the dissection involves supra-aortic branches and compromises previously placed stents. Methods: We report the case of a 58-year-old male presenting with ATAAD and left lower limb paralysis, with a history of prior TEVAR. Imaging demonstrated an entry tear in the ascending aorta with extension into the distal left main and supra-aortic branches, resulting in a dissection flap obstructing the proximal end of the TEVAR stent. The patient underwent emergency surgical intervention including a Bentall procedure, coronary artery bypass grafting (CABG), and deployment of a small Ascyrus Medical Dissection Stent (AMDS) distally within the TEVAR stent. Pre-operatively, the patient had severe lower limb ischemia due to near-complete obstruction of distal flow. Results: Following surgical intervention, there was restoration of true lumen perfusion with resolution of malperfusion. The patient was successfully weaned from cardiopulmonary bypass, extubated on post-operative day 4, and discharged on day 7 with stable hemodynamics and intact bilateral lower limb perfusion. Post-operative computed tomography (CT) demonstrated a well-seated AMDS with no evidence of ongoing false lumen perfusion. At 30-day follow-up, there was no clinical or biochemical evidence of organ malperfusion. Conclusions: The use of an AMDS deployed within a pre-existing TEVAR stent may represent an effective strategy for managing complex ATAAD with malperfusion, particularly in cases requiring combined surgical interventions. Full article

Background/Objectives: Ascending aortic aneurysm is a heterogeneous disease, with many cases of acute Stanford type A aortic dissection (ATAAD) presenting with aortic diameters below currently recommended surgical thresholds. Demographic factors such as age and sex, along with indexed aortic size groups, have been proposed to improve risk stratification. Methods: We included 65 adult patients who underwent surgical intervention for ATAAD. Morphometric measurements were obtained from computed tomography angiography (CTA) using centerline reconstruction. Maximum ascending aortic diameter and length were measured. Indexed parameters included the aortic size index (ASI), aortic height index (AHI), aortic length index (ALI) and cross-sectional aortic area indexed to height (CSA/H). Estimated pre-dissection dimensions were derived by reducing diameter by 18% and length by 2.7%. The cohort was stratified by age-, sex-, and ASI-defined groups. Results: Women were older than men (mean age 67 [SD 11] vs. 58 [SD 13] years, p = 0.01). Aortic diameter and length did not differ significantly by age or sex. At presentation, an ascending aortic diameter < 5.0 cm was observed in 37.1% of patients aged < 65 years and 26.7% of those aged ≥ 65 years. When stratified by sex, 25.0% of women and 35.6% of men presented with an ascending aortic diameter < 5.0 cm. Indexed parameters (ALI, AHI and ASI) were higher in older patients and women despite their smaller body size. In estimated pre-dissection analyses, less than 10% of the patients had diameters ≥ 5.5 cm, whereas most had estimated diameters < 5.0 cm. Conclusions: A substantial proportion of patients with ATAAD present with aortic dimensions below the current surgical thresholds. These findings underscore the limitations of diameter-based criteria and support the potential value of indexed geometric parameters in improving risk assessment in ATAAD patients. Full article

Objectives: Malperfusion is a major determinant of outcome in acute type A aortic dissection (ATAAD), yet its heterogeneous patterns and prognostic impact remain incompletely defined. We investigated the association between malperfusion burden, territory-specific involvement, and early outcomes after emergency ATAAD repair. Methods: We performed a retrospective single-center study including 483 consecutive patients undergoing emergency surgery for ATAAD (2010–2022). Malperfusion was classified by coronary, visceral, and peripheral territories and stratified as none, single-territory, or multidistrict (≥2 territories). The primary outcome was in-hospital mortality. Secondary outcomes included stroke, renal replacement therapy, peri-procedural myocardial infarction, major vascular events, and a composite endpoint of major adverse events (MAEs). Multivariable logistic regression identified independent predictors. Results: Overall, 68.5% of the population were male with a mean age of 65.4 ± 12.1 years. Malperfusion was present in 151 patients (31.3%), including 131 (27.1%) with single-territory and 20 (4.1%) with multidistrict involvement. In-hospital mortality increased stepwise with malperfusion burden (12.7%, 19.8%, and 50.0%; p < 0.001). MAEs occurred in 36.6% of patients, with a similar gradient (31.2%, 46.2%, and 65.0%, p < 0.001). In multivariable analysis, preoperative shock, neurological deficit, descending aortic involvement, and redo surgery were independent predictors of MAEs, whereas malperfusion burden showed an attenuated association after adjustment. Territory-specific analyses revealed strong associations between coronary malperfusion and peri-procedural myocardial infarction, visceral malperfusion and postoperative dialysis, and peripheral malperfusion and major vascular events. Conclusions: Malperfusion burden is associated with worse early outcomes after ATAAD repair but largely reflects underlying clinical severity. Distinct malperfusion territories confer specific postoperative risks, supporting a pattern-based approach to perioperative risk stratification. Full article

Background: An aortic disease diagnosis can be perceived by patients as a stressful and often life-altering event. In addition, an acute event, such as aortic rupture or dissection—and the surgical intervention that will be required to address it—can be viewed as potentially life-threatening and traumatic. Serious health conditions, including stroke and acute coronary syndromes, have been described in the literature to correlate with trauma-like symptoms. Post-traumatic stress disorder (PTSD) is well described in connection with external traumatic events, such as war, assault and similarly catastrophic events. A key element of this type of PTSD is that its occurrence arises secondary to an external traumatizer. However, recent work has suggested that internal events—such as a catastrophic medical event (e.g., acute cardiovascular event and/or surgery)—can trigger PTSD symptoms. An important question is whether medical event-initiated PTSD can (or should) be treated similarly to traditionally defined PTSD, when the triggering threat may persist rather than having been confined to a past event. This systematic review will summarize the literature on the occurrence of PTSD as a consequence of an acute cardiovascular event and attempt to identify effective treatments using meta-analysis, if the literature quantity and quality support it. Methods: The search strategy will include publicly available electronic databases, including MEDLINE via PubMed and OVID, EMBASE via Elsevier, Cumulative Index for Nursing and Allied Health Literature (CINAHL) via EBSCOhost, SCOPUS, PsychInfo, and the Cochrane Library, to identify publications that report the development and/or treatment of PTSD as a consequence of an acute cardiovascular event, which include cardiac arrest, acute coronary syndromes, and acute aortic syndromes. Identification of publications, article classification, methodological review/quality assessment, and data extraction will be performed by two trained experts in cardiovascular epidemiology, with the resolution of disagreements carried out by a third independent reviewer. The review conduct and meta-analysis will follow PRISMA and MOOSE guidelines. Data will be aggregated using random effects models when quantitative data are reliable and heterogeneity is reasonable. If a quantitative synthesis is not possible due to data quality, a narrative synthesis will be conducted. Statistical heterogeneity will be assessed by I² statistics. The quality of evidence will be assessed using the GRADE criteria. Ethics and Dissemination: This study did not require an institutional review board or human subjects protection committee approval given the nature of the study design. The results will be published in a peer-reviewed journal, along with recommendations for future research. Full article

Acute type A aortic dissection is a life-threatening condition requiring emergency surgery and complex postoperative management. Although survival rates have improved, many patients experience long-term functional impairments, reduced quality of life, and an elevated risk of complications. Despite strong evidence supporting cardiac rehabilitation in other cardiovascular populations, structured programs remain underutilized in patients with surgically resolved acute type A aortic dissection. Exercise-based cardiac rehabilitation appears feasible and can be delivered safely in carefully selected patients when appropriately adapted to individual needs and conducted under close supervision. Postoperative patients are often physically deconditioned, prone to hospital-acquired disability, and may misjudge exercise intensity. Therefore, individualized exercise prescription, guided by exercise testing when available, is important to support safe training thresholds. Early and gradual introduction of physical activity may help prevent complications associated with immobility, support blood pressure control, and contribute to improvements in functional capacity. However, training volume should be purposefully lower than in conventional program settings to reduce hemodynamic stress. Education on safe exercise parameters and self-monitoring plays a central role in enabling long-term adherence and promoting patient autonomy. Cardiac rehabilitation programs should incorporate dietary, nutritional, and psychological support. Although evidence specific to this patient population remains limited, available data suggest the feasibility and potential benefits of cardiac rehabilitation when delivered with appropriate precautions. Our review underscores the need for a tailored, multidisciplinary CR approach aimed at enhancing physical recovery, supporting cardiovascular stability, and improving overall quality of life in patients following surgery. Further research is required to define optimal program protocols. Full article

Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency characterized by important sex-related differences in presentation, management, and outcomes. Although women account for a smaller proportion of cases, they typically present at older ages and more frequently exhibit atypical symptoms, hemodynamic instability, and complications such as pericardial effusion or tamponade, contributing to diagnostic delays and higher pre-hospital mortality. Beyond clinical factors, biological differences may influence disease expression in women. Menopause-associated vascular aging, hormonal modulation of extracellular matrix remodeling, and pregnancy-related hemodynamic and connective tissue changes may alter aortic wall integrity and susceptibility to dissection. Notably, women often experience dissection at smaller absolute aortic diameters, highlighting the potential importance of body-size indexing in risk stratification and surgical thresholds. In type A AAD, women are less likely to undergo extensive surgical repair in some cohorts, and although contemporary in-hospital mortality differences are narrowing, long-term survival disparities may persist. In type B AAD, women are more frequently managed conservatively, while outcomes following thoracic endovascular aortic repair appear broadly comparable between sexes. Pregnancy and the postpartum period represent particularly vulnerable windows, especially among patients with underlying heritable aortopathies. Greater awareness of sex-specific biological and clinical characteristics, incorporation of indexed aortic dimensions, and improved multidisciplinary management strategies are essential to optimize outcomes for women with acute aortic dissection. Full article

Background: Acute type A aortic dissection complicated by mesenteric malperfusion syndrome (ATAAD-MMPS) is a highly lethal emergency with diagnostic challenges due to rapid progression and non-specific symptoms. This pilot study aimed to characterize the serum metabolomic and lipidomic alterations specific to ATAAD-MMPS and identify potential early diagnostic biomarkers. Methods: Serum samples from healthy controls, patients with uncomplicated ATAAD, and patients with ATAAD-MMPS were analyzed using targeted metabolomics and lipidomics. Multivariate statistical analyses were performed to discriminate between groups and identify differentially abundant metabolites and lipids. Pathway analysis was conducted to explore underlying pathological mechanisms. Results: Metabolomic profiles clearly distinguished ATAAD-MMPS from uncomplicated ATAAD, whereas lipidomic changes were primarily associated with ATAAD itself rather than the presence of mesenteric malperfusion. Metabolic pathway analysis revealed significant perturbations in the citric acid cycle, suggesting mitochondrial involvement as a potential pathological feature. Notably, methylguanidine was uniquely and markedly elevated in the ATAAD-MMPS group, demonstrating potential diagnostic value in distinguishing this lethal complication from uncomplicated ATAAD in this exploratory cohort (AUC = 0.923). Conclusions: This pilot study identifies distinct metabolic signatures associated with mesenteric malperfusion in ATAAD, with mitochondrial metabolic perturbations emerging as a potential contributing mechanism. Methylguanidine represents a candidate early diagnostic biomarker for ATAAD-MMPS, warranting validation in larger prospective studies. These findings provide a foundation for improved diagnostic strategies for this devastating condition. Full article

Type A aortic dissection represents one of the most life-threatening cardiovascular emergencies, with management strategies evolving toward hybrid and endovascular approaches, particularly in high-risk patients. The Ascyrus Medical Dissection Stent (AMDS) is an emerging adjunctive technology designed to promote true lumen expansion and facilitate favorable aortic remodeling during open repair of acute Type A dissection. We present the first reported case of AMDS deployment in secondary Type A dissection following prior thoracic endovascular aortic repair (TEVAR). An 83-year-old female with extensive aortic history—including TEVAR in 2012 for intramural hematoma with chimney stenting to the left subclavian artery and carotid–subclavian bypass in 2013—developed acute Type A dissection extending into the existing stent graft in 2024. Emergency surgical intervention included ascending aortic replacement, aortic arch repair with AMDS implantation, aortic valve resuspension, and left atrial appendage resection under cardiopulmonary bypass and hypothermic circulatory arrest. Postoperative imaging confirmed appropriate AMDS positioning, false lumen exclusion, and preservation of prior endograft integrity. The patient tolerated the procedure well and was discharged in stable condition with favorable early follow-up outcomes. This case demonstrates the potential role of hybrid surgical strategies and adjunctive endovascular devices in managing complex, multi-stage aortic disease. Full article

Objectives: The aim of this study was to compare the short- and long-term results of patients who had received aortic valve-sparing reimplantation (David I procedure) vs. aortic root replacement using a composite graft combined with a hemiarch replacement for acute type A aortic dissection (ATAAD) in a propensity score matching analysis. Methods: In this retrospective study we compared the outcomes before and after propensity score matching of patients who underwent emergency surgical repair for ATAAD requiring replacement of the aortic hemiarch with replacement of the aortic root between 2001 and 2023 at our institute. The 154 patients were divided into two groups: the first group consisted of patients undergoing David (n = 59), and the second group of patients undergoing Bentall (n = 95) procedures combined with an aortic hemiarch replacement. To reduce the confounding impact of pre-operative variables in this non-randomized study, 1:1 propensity score matching using the Nearest-Neighbour Matching algorithm was used. Results: Patients in the David plus Hemiarch group were significantly younger (62.16 ± 12.35 vs. 55.55 ± 10.80, p = 0.001). After the propensity score matching there were no significant differences between the two groups regarding intra-operative variables and hospital outcomes. In-hospital death was 15% (n = 6) in the David plus Hemiarch group compared to 24% (n = 10) in the Bentall plus Hemiarch group (15% vs. 24%, p = 0.40). Operation time was also similar between the two groups, being 402 and 384 min, respectively. Survival analyses also did not show any difference in long-term survival between both groups. Conclusions: When a standardized hemiarch replacement was used, no significant differences in short- and long-term outcomes were observed between a valve-sparing procedure and composite graft replacement in patients undergoing surgical repair for ATAAD. Surgeons should opt for the surgical strategy they are most comfortable with. This study represents one of the few analyses comparing the David and Bentall techniques in ATAAD patients undergoing standardized hemiarch replacement. Despite its retrospective nature, it provides clinically relevant insights for surgical decision-making in emergency settings. Full article

Background: To describe an aortic arch incision and closure technique (AICT) for proximal fixation of a frozen elephant trunk (FET) and to report early outcomes. Methods: We retrospectively reviewed 15 consecutive patients who underwent distal arch repair with an FET using AICT (mean age 77 ± 7 years; 14 men). Indications were distal arch aneurysm (n = 12), acute Stanford type B dissection (n = 2), and distal arch enlargement after thoracic endovascular aortic repair (n = 1). Under circulatory arrest, an oblique arch aortotomy was created, the FET was deployed antegrade, trimmed, and sutured to the native aortic wall during simultaneous closure, allowing extended posterior fixation. Clinical outcomes and postoperative computed tomography were assessed. Results: No ischemic complications related to graft kinking or thrombosis, reoperation for bleeding, stroke, spinal cord ischemia, or organ failure occurred. One patient died of pneumonia on postoperative day 47 (6.7%). Cervical branch reconstruction was required in 12 patients (80%), whereas two patients with type III arch morphology and acute angulation were treated without debranching via a Zone 3 aortotomy. At a median follow-up of 29 months, no proximal endoleak was observed; one distal endoleak occurred without reintervention. Coronary bypass grafts remained patent in all patients with concomitant or prior CABG. Conclusions: AICT provided secure proximal FET fixation and arch closure while preserving the ascending aorta, offering an alternative to total arch replacement in selected distal arch pathologies. Full article