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.