Eligibility Criteria of Studies and Data Extraction
Studies ascertained eligibility if those provided total aortic arch
replacement with FET through median sternotomy in the ATAAD patients.
Proximal arch or hemiarch procedures (i.e., procedures that did not
replace the entire arch) and other pathologies (i.e., aneurysm) were
excluded. Additional inclusion criteria included all observational
studies reporting more than 20 patients undergoing the FET procedure and
providing data for postoperative outcomes. Studies reported a
combination of patients with varying pathologies was excluded if pre-
and post-operative data were not reported for ATAAD individually. To
exclude duplicated or overlapped populations from the same institution,
these publications were identified. The latest report or those with the
largest sample size without overlapped time were included in the final
analysis.
After excluding case reports, conference presentations, editorials,
expert opinions, and duplicated evidence, all titles and abstracts were
reviewed by two independent reviewers (MM and YR), and irrelevant ones
were excluded. The full-text articles were retrieved in those that met
our inclusion criteria (Figure 1). The data extraction was independently
performed by two authors (MM and YR). If necessary, discrepancies were
resolved by consensus or discussion with the senior and corresponding
authors (MB and SH). The extracted data included baseline
characteristics (i.e., age, sex, cardiovascular risk factors, smoking
history, prior surgery, chronic kidney disease, and history of stroke).
Procedure-related features (i.e., concomitant procedures, procedure
duration, cardiopulmonary bypass time, circulatory arrest time,
cannulation site, and stent type) and postoperative follow-up outcomes
(i.e. mortality, acute kidney injury, post-operative bleeding, transient
or permanent stroke, and spinal cord injury) were also extracted and
recorded.