Search Strategy and Selection Criteria
A biomedical information specialist performed a comprehensive search on 21 February 2022 in Embase, Medline, Web of Science, Cochrane, and Google Scholar databases (search terms are available in Supplementary Material). Two researchers (D.A. and G.T.) independently reviewed abstracts and full texts based on predefined inclusion/exclusion criteria. Observational studies, both retrospective and prospective, and randomized controlled trials (RCTs) that reported outcomes after aortic arch surgery in adults with a sample size ≥ 10 patients, published in English, were included. Non-original studies (reviews), case reports, poster publications, conference presentations, animal studies, editorials, studies not defining or incomplete reporting of outcome and data were excluded. Studies had to compare at least two study arms to be eligible for inclusion in the network meta-analysis. Furthermore, studies reporting on hybrid aortic arch procedures, other than frozen elephant trunk, solely redo cases, type B aortic dissections, articles on exclusively concomitant procedures, mini-sternotomy and all different approaches other than median sternotomy were excluded. In case of disagreement, an agreement was negotiated until consensus was reached. In case of multiple publications on overlapping study populations, the largest series were included.