\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}



\usepackage{float}








\begin{document}

\title{Single-center experience and evolution of technique with the E-vita Open
prosthesis.}



\author[1]{Luis Maroto}%
\author[1]{Manuel Carnero}%
\author[1]{Francisco Cobiella}%
\author[1]{Rosa Beltrao}%
\author[1]{Enrique Villagrán}%
\author[1]{Fernando Reguillo}%
\author[1]{Daniel Pérez-Camargo }%
\affil[1]{Hospital Clínico San Carlos}%


\vspace{-1em}



  
  \date{May 26, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Background: We report our experience in aortic arch repair with the
E-vita Open hybrid prosthesis and describe the changes in our technique
over time. Methods: Between October 2013 and December 2019, 56 patients
underwent a total aortic arch replacement with the E-vita Open hybrid
prosthesis. Main indications were thoracic aorta aneurysm (n=27) and
acute type A aortic dissection (n=18). We analyze the technique and
results in the overall series, and compare both between our early (Group
I, 25 patients) and late experience (Group II, 31 patients). Results:
Overall in-hospital mortality was 7.1\% (4), and permanent stroke and
spinal cord injury were 3.6\% and 1.8\% respectively. 15 patients
(26.8\%) underwent a planned second procedure on the distal aorta: 13
endovascular, 1 open and 1 hybrid. Survival at 1 and 3 years was 90.7\%
and 80.7\%. Group II included more patients with acute dissection
(45.2\% vs 16\%, p=0.02), a higher rate of bilateral cerebral perfusion
(100\% vs 64\%, p\textless{}0.001), left subclavian artery perfusion
during lower body circulatory arrest (87.1\% vs 0\%, p\textless{}0.001),
early reperfusion (96.8\% vs 40\%, p\textless{}0.001), and zone 0-2
distal anastomosis (100\% vs 72\%, p=0.02). In-hospital mortality (3.2\%
vs 12\%) and permanent stroke (0\% vs 8\%) tended to be lower in Group
II. Conclusions: Total arch replacement with E-vita Open hybrid
prosthesis in complex thoracic aorta disease is safe. One-stage
treatment is feasible when pathology does not extend beyond the proximal
descending thoracic aorta. In any case, it facilitates subsequent
procedures on distal aorta if needed.%
\end{abstract}%



\sloppy


\textbf{Introduction}

Surgical treatment of extensive thoracic aortic disease usually implies
either an aggressive one-stage procedure using bilateral anterior
thoracotomy and transverse sternotomy\textsuperscript{1} or a two-step
procedure\textsuperscript{2}, both with high morbidity and mortality.
The \emph{frozen elephant trunk} (FET) technique with hybrid prostheses
was developed to treat in a one-stage procedure and through median
sternotomy the ascending aorta, aortic arch and proximal descending
aorta. In addition, it facilitates subsequent procedures on distal aorta
by endovascular, open or hybrid techniques\textsuperscript{3-5} if
needed.

This study describes our experience with the E-vita Open hybrid
prosthesis and the changes of the technique between 2013 and 2019.

\textbf{Materials and Methods}

\emph{Patients}

This retrospective study was approved by our local ethics committee.
Data was collected prospectively in our institutional database. From
October 2013 to December 2019, 56 consecutive patients underwent a
complete aortic arch replacement using the E-vita Open hybrid
prosthesis. All the procedures were performed by two experienced
surgeons. Main underlying diseases were degenerative aneurysm (n=27) and
type A acute aortic dissection (n=18). Patients characteristics are
presented in Table 1.

As we gained experience (Figure 1), indications expanded to more complex
diseases, and the technique was standardized. We compared the surgical
technique and operative results between our early (Group I, October
2013-December 2017, n=25) and late experience (Group II, January
2018-December 2019, n=31).

\emph{Surgical technique}

All operations were performed under general anesthesia and through
median sternotomy. Patients were monitorized with transesophageal
echocardiography, bilateral cerebral saturation with near infrared
spectroscopy and three arterial lines (both radial arteries and one
femoral artery). We did not use cerebrospinal fluid (CSF) drainage.

After systemic heparinization, a pigtail catheter was placed in the
descending aorta under transesophageal echocardiography control and
through a 6F sheath in the femoral artery.

Arterial cannulation was performed directly or with an 8mm dacron graft
interposition to the target artery. According to the anatomy and
pathology, axillary, innominate or carotid arteries were used in order
to obtain antegrade flow in the thoracic aorta and to facilitate the
brain protection during circulatory arrest. In high-risk reoperated
patients, cardiopulmonary bypass (CPB) was started before performing the
sternotomy.

The operation was carried out under moderate hypothermia (20\selectlanguage{ngerman}ºC-28ºC).
Blood cardioplegia or crystalloid Bretschneider´s solution
(\emph{Custodiol, Dr. Franz Köhler Chemie GmBH, Alsbach-Hänlein,
Germany} ) was delivered antegradely, retrogradely or combined. Once the
heart was arrested, the aortic root or ascending aorta were repaired if
needed. When the target temperature was achieved, circulatory arrest was
instituted and antegrade selective cerebral perfusion was initiated.
Aortic arch was resected, and distal aorta tailored to place the
prosthesis.

The E-vita was placed antegradely. The prosthesis was inserted with a
though-and-through wire technique with a 0.035'' extra stiff guidewire,
that was introduced retrogradely through the pigtail catheter. Although
the landing zone depended upon the extension of the disease, we changed
the distal anastomosis site to zone 2 or more proximally over time.
Graft size was chosen according to the etiology: 10-20\% oversizing in
aneurysms and no oversizing in acute and chronic dissection.

Brain protection was achieved with unilateral or bilateral selective
antegrade perfusion (SACP), and flow was adjusted to 10-15 mL/Kg/min and
50-60mmHg pressure. In order to improve the protection of the brain and
spinal cord, we modified our technique to 1) perfuse the left subclavian
artery (LSA) during lower body circulatory arrest and 2) early re-
perfuse the thoracoabdominal aorta after the distal anastomosis was
completed (Figure 2). LSA was dissected and ligated proximally during
cooling. Its distal aspect was connected to the arterial line with an 8
mm dacron graft, which posteriorly, was anastomosed to the ascending
aorta graft during rewarming. If supra-aortic arteries had to be
re-implanted through a trifurcated graft, a femoral artery was also
cannulated, and distal anastomosis were performed sequentially from the
innominate artery to the LSA during cooling. The hybrid prosthesis was
anastomosed to the distal remanent of the aorta with a double layer 3/0
polypropylene running suture and an external polytetrafluoroethylene
felt.

Once the distal anastomosis was finished, a balloon catheter
(\emph{Reliant, Medtronic, Mn, United States} ) was inserted antegradely
to occlude the stent graft. Then, the blood flow in the thoracoabdominal
aorta was resumed through the femoral artery and rewarming was started.
If femoral cannulation had not been performed because of peripheral
vascular disease or extensive dissection affecting the femoral arteries,
a Foley catheter was used to occlude the stent graft and to perfuse the
distal aorta. Then, supra-aortic arteries were implanted to the vascular
graft, using three different techniques depending on the anatomy and
pathology: \emph{en-block} , \emph{en-block} (IA, LCA) and LSA bypass or
through a self-made trifurcated graft. We systematically avoid clamping
the arch graft, but rather maintain the balloon catheter into the stent
graft until the arch graft is anastomosed to the ascending aorta with a
4/0 polypropylene running suture. In this way, it is easier to size the
length of the arch prosthesis.

\emph{Follow-up}

Discharged patients were examined at the outpatient clinics after one,
three and 6 months, and yearly thereafter. Computed tomography (CT)
scans were performed at discharge, at three months and yearly.

\emph{Statistical analysis}

SPSS 25.0 statistical package (\emph{IBM Corp, Armonk, NK, USA} ) was
used. \emph{Saphiro-Wilk} test was used to test normality. Continuous
variables were presented with mean ± standard deviation (SD) or median
and interquartile range (IQR). Categorical variables were presented in
absolute and relative frequency. Two-side unpaired t-test
and\emph{Fischer´s-exact test} were used for comparison of continuous
and categorical variables, respectively. \emph{Kaplan-Meier} analysis
was used for survival analysis.

\textbf{Results}

\emph{In-hospital stay}

Intraoperative results are presented in Table 2. The right axillary
artery is the most frequent artery for cannulation (n=33, 58.9\%). Brain
protection was achieved with bilateral perfusion in most of the patients
(n=47, 83.9\%). The E-vita Open prosthesis was deployed in Zone 2 in 42
cases (75\%). CPB, myocardial ischemia, SACP and lower body circulatory
arrest times were 183±49 min, 109±40 min, 75±28 min and 42±18 min,
respectively.

As our experience grew (Figure 1) indications expanded and the technique
evolved (Table 2). Thereby, main indications for surgery in group I were
degenerative aneurysms (56\%, n=14), and surgery was elective in 76\%
(n=19). On the contrary, in group II, the main indication for surgery
was type A acute dissection (45.2\%, n=14), and 48.8\% (n=15) of
patients were operated on an urgent or emergent situation.

Regarding the technical modifications, in group II as compared to group
I, brain protection was achieved under bilateral selective antegrade
perfusion (100\% vs 64\%, p\textless{}0.001), distal anastomosis was
moved to Z0-Z2 (100\% vs 72\%, p=0.02), core temperature was higher
(25±2 vs 22±3, p\textless{}0.001), LSA was perfused during lower body
circulatory arrest (87.1\% vs 0\%, p\textless{}0.001) and
thoracoabdominal aorta perfusion was reestablished after distal
anastomosis (96.8\% vs 40\%, p\textless{}0.001). These modifications
resulted in a significant reduction of the lower body circulatory arrest
time (33±1min vs 54±2min, p\textless{}0.001). Other modifications
included arterial cannulation with graft interposition in almost any
patient (96.8\% vs 36\%, p\textless{}0.001), innominate artery as our
artery of choice for cannulation (48\% vs 16\%, p=0.01) and crystalloid
Bretschneider´s solution for myocardial protection (96.8\% vs 36\%,
p\textless{}0.001).

Hospital mortality was 7.1\% (n=4) (Table 3). Causes of death were
intraoperative hemorrhage, stroke, sepsis and respiratory failure.

Permanent stroke and spinal cord injury occurred in 3.6\%(n=2) and
1.8\%(n=1) respectively. Laryngeal nerve lesion occurred in 3.6\% (n=2).
Hospital mortality (12\%, n=3 vs 3.2\%, n=1; p=0.31), permanent stroke
(3.6\%, n=2 vs 0\%, n=0; p=0.28), and laryngeal nerve lesion (8\%, n=2
vs 0\%, n=0; p=0.1) were less frequent in Group II (Table 3). Median ICU
and hospital stay were 4 days (IQR 3-13 days) and 15 days (IQR 10-34
days), respectively, with no differences between Group I and II.

\emph{Follow-up}

No patient required unplanned intervention on distal aorta. Fifteen
patients (26.8\%) underwent a scheduled second stage (Figure 3): 12
aneurysms extending to the distal portion of the descending aorta, 2
thoracoabdominal aorta aneurysms and 1 type A chronic aortic dissection.
Thirteen patients were treated endovascularly (12 thoracic endovascular
aortic repair -TEVAR- and 1 fenestrated/branched endovascular aneurysm
repair), 1 patient underwent an open repair and 1 patient a hybrid
approach (TEVAR extension of E-vita Open prosthesis and subsequently
open repair of distal aorta).

Mid-term clinical follow-up was achieved for all the patients (mean
follow up: 20.9±18 months). One- and three-year overall survival was
90.7\% and 80.7\% (Figure 4). Three patients underwent a reintervention
during the follow-up. Reasons were type Ib endoleak (n=1),
pseudoaneurysm of the supra-aortic arteries patch anastomosis (n=1) and
a distal false lumen enlargement in a Type A chronic dissection.

In acute and chronic dissections, a follow-up CT scan at 3 months was
available in 24/26 patients. No stent induced new entry was detected.
Complete thrombosis at mid portion of the stent-grafted aortic segment
was observed in 79.2\% of patients (87.5\% in acute dissection and
62.5\% in chronic dissection, p=0.2) and at its distal aspect in 50\%
(56.3\% in acute dissection and 37.5\% in chronic dissection, p=0.6).
Distal to the stent graft, complete false lumen perfusion remained in
62.5\% (50\% in acute dissection and 85.7\% in chronic dissection,
p=0.1).

\textbf{Discussion}

Endovascular repair is the treatment of choice for aneurysms or
dissections of the thoracic descending aorta. When the disease extends
to the arch, endovascular treatment is not a good option in most
cases\textsuperscript{7} and open repair is challenging. The development
of hybrid prostheses and the FET procedure\textsuperscript{8-10} has
simplified the surgical treatment of these pathologies, allowing either
a single-stage open procedure, or facilitating an open or endovascular
second stage\textsuperscript{11,12}. In acute and chronic dissections
FET stabilizes the true lumen, covers the reentry sites in proximal
descending thoracic aorta and promotes false lumen thrombosis and aortic
remodeling, reducing the risk of distal aorta rupture and
reinterventions\textsuperscript{3-5}.

Two different hybrid prosthesis are available in Europe: The E-vita Open
(\emph{Jotec GmbH, Hechingen, Germany} ) and the Thoraflex
(\emph{Vascutek, Terumo, Inchinnan, UK} ). The E-vita Open is the
prosthesis of choice at our center. Its main advantage is the
intussuscepted position of the arch prosthesis, which facilitates the
distal anastomosis. On the contrary, the lack of a side branch requires
additional maneuvers to establish early reperfusion.

Authors from Essen have reported the greatest experience with E-vita
Open prosthesis. They operated on 307 patients from 2005 to 2018.
In-hospital mortality was 13.4\%. Permanent cerebral and spinal cord
deficit occurred in 7.2\% and 2.9\%, respectively\textsuperscript{13}.
Freedom from reintervention (open or endovascular) in distal aorta was
73\% at 8 years. In acute type A aortic dissections, the false lumen
remained thrombosed or resolved completely along the stent-graft aortic
segment in 90\% of patients. Authors from Hannover and Bologna have
published their combined experience in 437 patients from 2007 to 2017.
Three different hybrid prosthesis were used: the Chavan-Haverich
(\emph{Hannover, Germany} ), the E-vita Open and the
Thoraflex\textsuperscript{14}. In-hospital mortality was 14.9\%.
Permanent stroke and spinal cord injury rates were 10.8\% and 5.5\%,
respectively. 23.1\% of patients required an additional procedure, open
or endovascular, during follow-up.

Although our series is still short, results are similar to those centers
with greater experience. In-hospital mortality, permanent stroke and
spinal cord injury were 7.1\%, 3.6\% and 1.8\%, in spite of a high
preoperative risk (type A acute dissections 32.1\%, urgent surgery
37.5\% and previous cardiac surgery in 19.6\%). This is due in part to
an adequate patient selection, a case-to-case procedure planning, a
limited and consistent operating room team (surgeon, nursing,
anesthesiology and perfusion) and the standardization of the procedure.
In our opinion, FET procedure is more reproducible than standard surgery
in complex thoracic aortic disease, enabling small groups like ours to
have comparable outcomes to bigger centers.

Since 2013 surgical technique has evolved. We have moved the distal FET
anastomosis to Zone 0-2, started to perfuse the LSA during lower body
circulatory arrest and perfusion in the thoracoabdominal aorta is
reestablished once distal anastomosis is performed. \emph{Tsagakis et
al} showed that the combination of Z2 anastomosis, LSA perfusion and
early reperfusion reduced the risk of postoperative renal replacement
therapy, prolonged intubation, re-exploration for bleeding and laryngeal
nerve lesion\textsuperscript{13}. In our series in-hospital mortality
and permanent stroke were reduced to 3.2\% and 0\% in the last two years
(group II), respectively. This is probably related not only to the
technique improvement but also to the greater experience. Z0, 1 o 2
anastomosis is less technically demanding. In addition, it is easier to
reach in case of bleeding, reduces the risk of laryngeal nerve injury
and avoids left pleural cavity opening.

We switched to bilateral antegrade cerebral perfusion because it is an
easy maneuver which warrants an adequate perfusion of both
hemispheres\textsuperscript{15}. Although a very low stroke rate has
been published with unilateral perfusion\textsuperscript{16}, concern
remains when the duration of selective perfusion is more than 50
minutes\textsuperscript{17}.

Z2 anastomosis is combined with debranching of the LSA with an 8-mm
dacron graft or all three supra-aortic arteries with a trifurcated graft
during cooling. In this way, FET procedure is performed under perfusion
of all supra-aortic arteries, improving cerebral and spinal cord
perfusion during lower body circulatory arrest. To date, we have been
able to dissect the LSA during cooling in all cases. When anatomy is
unfavorable with a displaced LSA origin, an extension of the sternotomy
incision to the left neck is done in order to get a wide left carotid
artery dissection and mobilization. Alternatively, an extra-anatomic
bypass to axillary artery through second intercostal space can be
performed\textsuperscript{3}.

Other improvements in our surgical technique were the interposition of a
graft for arterial cannulation and the use of crystalloid
Bretschneider´s solution for myocardial protection. First, the
innominate artery became our first-choice artery for cannulation, as
additional incisions are not required, and it is easy to access. In
addition, an 8mm dacron graft is now systematically interposed to
diminish the risk of retrograde dissection and improve distal
perfusion\textsuperscript{18} . Secondly, due to the complexity of this
procedure, optimal myocardial protection plays a key role in achieving a
successful outcome. Crystalloid Bretschneider´s cardioplegia allows a
prolonged myocardial protection in a single dose\textsuperscript{19}.
Finally,

The growing experience and the shorter lower body circulatory arrest
time (Group I 54±20min versus Group II 33±10min, p\textless{}0.001) made
it possible to raise nasopharyngeal temperature (Group I 22±3ºC vs Group
II 25±3ºC). Length of stent graft was significantly shorter in Group II
(135.5±5mm versus 150±9mm), which is explained because acute dissections
are more frequent in this group (45.2\% versus 16\%). In acute aortic
dissections, shorter stent grafts (130mm) are enough to cover the
reentry sites in proximal descending thoracic aorta and promote false
lumen thrombosis.

We must not forget that FET is a major surgery which combines prolonged
time on CPB, hypothermic circulatory arrest and is frequently performed
in high risk patients, so it is not exempted of significant
complications\textsuperscript{3-5,13,14}. Permanent stroke and specially
spinal cord ischemia are the most feared and devastating. In a recent
meta-analysis, \emph{Preventza et al} analyze the pooled outcome of 3154
patients from thirty-five studies who underwent a FET procedure.
In-hospital mortality was 8.8\%, and permanent stroke and spinal cord
injury (SCI) rates were 7.6\% and 4.7\%, respectively. Stent length of
15cm or greater and coverage extending to T8 were associated with a
higher risk of spinal cord ischemia. The proposed mechanism is the
compromise of collateral flow from segmental arteries. Although its role
is unquestioned, there must be other factors involved, because the
incidence of SCI in endovascular treatment of thoracic aorta has a
significant lower rate\textsuperscript{21}. During open surgery, a
period of spinal cord ischemia occurs during circulatory arrest. During
SACP spinal cord is not perfused below T8-T9 and protection depends
primarily on temperature\textsuperscript{22}.On this basis, spinal cord
is at risk in FET procedures at moderate (28º-32º) temperatures with
long systemic circulatory arrest times (\textgreater{}60min). A third
factor is an inadequate spinal cord perfusion in the postoperative
period. Spinal cord suffers an ischemic insult during circulatory arrest
and several segmental arteries are occluded, so a period of systemic
hypotension can trigger the SCI\textsuperscript{23}. It is critical to
maintain an adequate perfusion pressure during perioperative period,
raising mean blood pressure over 70mmHg. Spinal cord perfusion pressure
can also be improved with the use of intraoperative CSF
drainage\textsuperscript{24}. Other factors involved in neurological
injury are hypoxia, anemia, hyperglycemia and
hyperthermia\textsuperscript{25}.

Paraplegia occurred in one patient: a 67-year-old woman operated in an
emergent situation because an acute type A aortic dissection. A 22x130mm
E-vita Open prosthesis was implanted in zone 0. She was extubated after
six hours without any neurological deficit. 24 hours after surgery she
presented a sudden massive hemorrhage and sustained severe hypotension.
She was transferred to the operating room and bleeding was controlled.
When she was extubated, 48h later, paraplegia was present. Magnetic
resonance imaging showed ischemic damage at T8 level. Despite
hemodynamic and metabolic optimization and CSF drainage, paraplegia was
permanent. Due to her small size (155 cm in height) the stent graft
covered thoracic aorta until T9. Our hypothesis is that although
collateral flow compensated initially the occlusion of segmental
arteries, hemorrhage and subsequent sustained hypotension triggered the
ischemia.

This study has several limitations. First, although data is collected
prospectively, its analysis is retrospective. Second, it is a single
center experience, which makes difficult to support the external
validity of our results. Finally, the sample size is small. We have
almost doubled the number of procedures since we started the FET
program; but, still, the center volume is low as compared to others
(Bologna, Essen or Hannover).

\textbf{Conclusions}

In conclusion, FET procedure using the E-vita Open hybrid prosthesis is
safe and the treatment of choice in complex thoracic aorta disease
involving the aortic arch. It makes feasible a single stage correction
when the disease does not extend beyond the proximal descending thoracic
aorta. Furthermore, it also promotes false lumen thrombosis in aortic
dissections and facilitates subsequent procedures on the distal aorta by
endovascular, open or hybrid approaches.

\textbf{Author contributions}

Luis C Maroto: Concept, Drafting article; Manuel Carnero: Drafting
article, Data analysis; Javier Cobiella: Critical revision; Rosa
Beltrao: Data collection; Enrique Villagrán: Data collection; Fernando
Reguillo: Critical revision; Daniel Pérez: Critical revision, Other.

\textbf{References}

\begin{enumerate}
\tightlist
\item
  Kouchoukos NT. One-stage repair of extensive thoracic aortic disease.
  J Thorac Cardiovasc Surg 2010;140:S150-3.
\item
  Etz CD, Plestis KA, Kari FA et al. Staged repair of thoracic and
  thoracoabdominal aortic aneurysms using the elephant trunk technique:
  a consecutive series of 215 first stage and 120 complete repairs. Eur
  J Cardiothorac Surg 2008;34:605-14.
\item
  Jakob H, Dohle D, Benedik J et al. Long-term experience with the
  E-vita Open hybrid graft in complex thoracic aortic disease. Eur J
  Cardiothorac Surg 2017;51:329-38.
\item
  Shrestha M, Martens A, Kaufeld T et al. Single-centre experience with
  the frozen elephant trunk technique in 251 patients over 15 years. Eur
  J Cardiothorac Surgery 2017;52:858-66.
\item
  Di Bartolomeo R, Pacini D, Savini C et al. Complex thoracic aortic
  disease: single-stage procedure with the frozen elephant trunk
  technique. J Thorac Cardiovasc Surg 2010;140(6 suppl):S81-5.
\item
  Abraha I, Romagnoli C, Montedori A, Cirocchi R. Thoracic stent graft
  versus surgery for thoracic aneurysm. Cochrane Database Syst Rev
  2016;6:CD006796. doi:10.1002/14651858.CD006796.pub4.
\item
  Rudarakanchana N, Jenkins MP. Hybrid and endovascular repair of the
  aortic arch. Br J Surg 2018;105:315-27.
\item
  Kato M, Ohnishi K, Kaneko et al. New graft-implanting method for
  thoracic aortic aneurysm or dissection with a stented graft.
  Circulation 1996;94(9 Suppl)II188-II193.
\item
  Karck M, Chavan A, Khaladj N, Kallenbach K, Weidemann J, Haverich A.
  The frozen elephant trunk technique for the treatment of extensive
  thoracic aneurysms: Operative results and follow-up. Eur J
  Cardiothorac Surg 2005;28:286-290.
\item
  Jakob H, Tsagakis K, Leyh R, Buck T, Herold U. Development of an
  integrated stent graft-dacron prosthesis for intended one-stage repair
  in complex thoracic aortic disease. Herz 2005;30:766-68.
\item
  Uchida N, Kodama H, Katayama K et al. Endovascular aortic repair as
  second-stage surgery after hybrid open arch repair by the frozen
  elephant trunk technique for extended thoracic aneurysm. Ann Thorac
  Cardiovasc Surg 2013;19:257-61.
\item
  Folkmann S, Weiss G, Pisarik H, Czerny M, Grabenwoger M.
  Thoracoabdominal aortic aneurysm repair after frozen elephant trunk
  procedure. Eur J Cardiothorac Surg 2015;47:115-9.
\item
  Tsagakis C, Jakob H. Which frozen elephant trunk offers the optimal
  solution? Reflections from Essen group. Sem Thoracic Surg
  2019;31:679-85.
\item
  Leone A, Beckmann E, Aandreas M et al. Total aortic arch replacement
  with frozen elephant trunk technique: Results from two European
  institutes. J Thorac Cardiovasc Surg 2020;159:1201-11.
\item
  Olsson C, Thelin S. Regional cerebral saturation monitoring with
  near-infrared spectroscopy during selective antegrade cerebral
  perfusion: diagnostic performance and relationship to postoperative
  stroke. J Thorac Cardiovasc Surg 2006;131:371-9.
\item
  Urbanski PP, Lenos A, Zacher M, Diegeler A. Unilateral cerebral
  perfusion:right versus left. Eur J Cardiothorac Surg 2010;37:1332-6.
\item
  Krähenbühl ES, Clément M, Reineke D et al. Antegrade cerebral
  protection in thoracic aortic surgery: lessons from the past decade.
  Eur J Cardiothorac Surg 2010;38:46-51.
\item
  Svensson LG, Blackstone EH, Rajeswaran J et al. Does the arterial
  cannulation site for circulatory arrest influence stroke risk? Ann.
  Thorac Surg 2004;78:1274-84.
\item
  Viana FF, Shi WY, Hayward PA, Larobina ME, Liskaser F, Matalanis G.
  Custodiol versus blood cardioplegia in complex cardiac operations: an
  Australian experience. Eur J Cardiothorac Surg 2013;43:526-31.
\item
  Preeventza O, Liao JL, Olive JK et al. Neurologic complications after
  frozen elephant trunk procedure: A meta-analysis of more than 3000
  patients. J Thorac Cardiovasc Surg 2019
  doi:10.1016/j.jtcvs.2019.10.031.{[}Epub ahead of print{]}
\item
  Katayama K, Uchida N, Katayama A et al. Multiple factors predict the
  risk of spinal cord injury after elephant trunk technique for extended
  thoracic aortic disease. Eur J Cardiothorac Surg 2015;47:616-20.
\item
  Etz CD, Luehr M, Kari FA et al. Selective cerebral perfusion at 28º C.
  Is the spinal cord safe? Eur J Cardiothorac Surg 2009;36:946-55.
\item
  Ullery BW, Cheung AT, Fairman RM et al. Risk factors, outcomes, and
  clinical manifestations of spinal cord ischemia following thoracic
  endovascular aortic repair. J Vasc Surg 2011;54:677-84.
\item
  Coselli JS, LeMaire SA, Koksoy C, Schmittling ZC, Curling PE.
  Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal
  aortic aneurysm repair: results of a randomized clinical trial. J Vasc
  Surg 2002;35:631-9.
\item
  Shann KG, Likosky DS, Murkin JM et al. An evidence-based review of the
  practice of cardiopulmonary bypass in adults: a focus on neurologic
  injury, glycemic control, hemodilution, and the inflammatory response.
  J Thorac Cardiovasc Surg 2006;132:283-90.
\end{enumerate}

\textbf{Table 1: Demographics}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Overall} \textbf{(n=56)} \textbf{N (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Group I} \textbf{(n=25)} \textbf{N (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Group II} \textbf{(n=31)} \textbf{N (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{p}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Age (mean\selectlanguage{ngerman}±SD)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
63\selectlanguage{ngerman}±12.1\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
63.6\selectlanguage{ngerman}±15\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
63.5\selectlanguage{ngerman}±9.3\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
37(66)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
17(68)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
20(64.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Etiology\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Aneurysm}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
27(48.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
14(56)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
13(41.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.42\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Acute dissection}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
18(32.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4(16)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
14(45.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.02}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Chronic dissection}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8(14.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(20)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(9.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.44\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{TEVAR complications}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Aortitis}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(1.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.44\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Extent of aortic disease\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\emph{Arch+descending aorta(±ascending)}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
23(41.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
11(44)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
12(38.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.32\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\emph{Arch+thoracoabdominal aorta(±ascending)}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
28(50)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(40)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
18(58.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.25\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Isolated descending aorta}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(8.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4(16)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Emergency(\textless{}24h)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
21(37.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(24)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
15(48.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.09\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Previous surgery (ascending aorta or arch)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
11(19.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(20)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(31)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.51\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Previous descending aorta repair\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(8.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(9.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.91\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Previous abdominal aortic repair\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4(7.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4(16)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.03}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Cardiac comorbidities\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Coronary artery disease}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(16.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(24)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(9.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.14\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Aortic valve disease}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
20(35.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7(28)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
13(41.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.27\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Mitral valve disease}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(1.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.36\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{EF\textless{}50\%}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(1.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.36\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Other comorbidities\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Diabetes}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7(12.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(20)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.09\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{CPOD}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
13(23.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7(28)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(19.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.44\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Creatinine clearance\textless{}60mL/min}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(10.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(12)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(12)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.78\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Stroke}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4(7.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(6.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.49\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

CPOD: chronic pulmonary obstructive disease, TEVAR: thoracic
endovascular aortic repair

\textbf{Table 2: Intraoperative results}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Overall} \textbf{(n=56)} \textbf{N (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Group I} \textbf{(n=25)} \textbf{N (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Group II} \textbf{(n=31)} \textbf{N (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{p}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Arterial cannulation\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Right axillary artery}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
33(58.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
20(80)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
13(41.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.006}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Innominate artery}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
19(33.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4(16)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
15(48)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.013}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Right carotid artery}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(6.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.29\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Left carotid artery}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.87\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Graft interposition}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
39(69.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(36)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
30(96.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Body temperature (mean\selectlanguage{ngerman}±SD)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
23.8\selectlanguage{ngerman}±3.4\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
22\selectlanguage{ngerman}±3.6\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
25\selectlanguage{ngerman}±2.8\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Myocardial protection\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Blood cardioplegia}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
16(28.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
15(60)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Crystaloid cardioplegia}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
40(71.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(40)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
30(96.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Brain protection\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Unilateral antegrade perfusion}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(16.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(36)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Bilateral antegrade perfusion}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
47(83.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
16(64)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
31(100)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
LSA perfusi\selectlanguage{ngerman}ón during visceral ischemia\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
27(48.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
27(87.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Early reperfusion\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
37(66.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(40)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
30(96.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Level of distal anastomosis\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Z3}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7(12.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7(28)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.02}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{\textless{}Z3}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
49(87.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
18(72)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
31(100)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.02}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Head vessels reimplantation\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{En-block}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(16.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(36)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{En block (IA+LCA) + LSA bypass}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
32(57.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
11(44)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
21(67.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.07\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Self-made trifurcated graft}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
15(26.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(20)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(32.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Aortic root\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Bentall-De Bono operation}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(16.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7(22.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.14\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{David operation}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(5.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.43\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Partial repair}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
13(23.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(12)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(32.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.01\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Evita-open size (mean\selectlanguage{ngerman}±SD)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Diameter (mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
29\selectlanguage{ngerman}±4.7\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
29\selectlanguage{ngerman}±4.1\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
29.15.4\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Length(mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
142\selectlanguage{ngerman}±12\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
150\selectlanguage{ngerman}±8.6\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
135.5\selectlanguage{ngerman}±11.5\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Concomitant procedures\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Mitral valve repair}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(1.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0(0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.36\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{CABG}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8(14.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(20)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(9.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.39\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Operative times (minutes, mean\selectlanguage{ngerman}±SD)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{CPB}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
183\selectlanguage{ngerman}±49.6\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
182\selectlanguage{ngerman}±48\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
184\selectlanguage{ngerman}±51\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.38\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Cardioplegic arrest}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
109.4\selectlanguage{ngerman}±40.4\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
107\selectlanguage{ngerman}±42\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
110\selectlanguage{ngerman}±39\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.26\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Selective cerebral perfusion}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
75.5\selectlanguage{ngerman}±28.1\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
75\selectlanguage{ngerman}±32\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
75\selectlanguage{ngerman}±25\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.48\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Lower body circulatory arrest}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
42.7\selectlanguage{ngerman}±18.4\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
54\selectlanguage{ngerman}±20\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
33\selectlanguage{ngerman}±10\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

CABG: coronary artery bypass grafting, CPB: cardiopulmonary bypass, IA:
innominate artery, LCA: left carotid artery, LSA: left subclavian
artery.

\textbf{Table 3. In-hospital morbidity and mortality}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Overall (n=56)} \textbf{N (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Group I} \textbf{(n=25)} \textbf{N (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Group 2 (n=31)} \textbf{N (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{p}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
In-hospital mortality\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4 (7.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3 (12)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1 (3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.31\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Permanent stroke\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2 (3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2 (8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0 (0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.28\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Transient stroke\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2 (3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1 (4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1 (3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.18\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Paraplegia\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1 (1.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0 (0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1 (3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.43\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Delirium\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6 (10.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2 (8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4 (12.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.69\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Laryngeal nerve lesion\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2 (3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2 (8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0 (0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Mechanical ventilation\textgreater{}72h\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
12 (21.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6 (24)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6 (19.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.67\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Temporary renal replacement\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3 (5.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1 (4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2 (6.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.68\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Reoperation for bleeding\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6 (10.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2 (8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4 (12.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.68\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Figure legends}

Figure 1: FET caseload per year.

Figure 2: CPB setup. A: CPB onset. B: Cooling. Left subclavian artery
bypass and proximal repair. C: Hypothermic circulatory arrest. Brain
perfusion. Distal anastomosis. D: Early reperfusion through right
femoral artery, rewarming and head vessels reimplantation.

Figure 3: Thoracic aorta aneurysm. A: Preoperative. B: After E-vita
Open. C: After endovascular extension.

Figure 4: Kaplan-Meier analysis for survival.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-2/Figure-2}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/FIgure-3/FIgure-3}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-4/Figure-4}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

