Modified Elephant Trunk Technique in Distal Anastomosis With the Aid of Antegrade Selective Cerebral Perfusion for Total Arch Replacement

Abstract OBJECTIVES We investigated the effect of a preoperative age ≥80 years on postoperative outcomes in patients who underwent isolated elective total arch replacement using mild hypothermic lower body circulatory arrest with bilateral antegrade selective cerebral perfusion. METHODS A total of 140 patients who had undergone isolated elective total arch replacement between January 2007 and December 2020 were enrolled in the present study. We compared postoperative outcomes between 30 octogenarian patients (≥80 years old; Octogenarian group) and 110 non-octogenarian patients (≤79 years old; Non-Octogenarian group). RESULTS Overall 30-day mortality and hospital mortality were 0% in both groups, and there was no significant difference in overall survival between the 2 groups (log-rank test, P = 0.108). Univariable Cox proportional hazard analysis showed that age as continuous variable was only the predictor of mid-term all-cause death (hazard ratio 1.08, 95% confidence interval 1.01–1.16; P = 0.037), but not in the Octogenarians subgroup (P = 0.119). CONCLUSIONS Preoperative age ≥80 years is not associated with worse outcomes postoperatively after isolated elective total arch replacement with mild hypothermic lower body circulatory arrest and bilateral antegrade selective cerebral perfusion.

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Use of endoluminal antegrade selective cerebral perfusion (ASCP) in the treatment of integrated total arch replacement

10.26226/morressier.57108e2fd462b80290b4978f ◽

2016 ◽

Author(s):

Anthony Ghosn

Keyword(s):

Cerebral Perfusion ◽

Total Arch Replacement ◽

Selective Cerebral Perfusion ◽

Antegrade Selective Cerebral Perfusion

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Use of On-Site Digital Subtraction Angiography for Left Subclavian Artery Management During Hybrid Aortic Arch Repair in DeBakey I Dissection

Journal of Endovascular Therapy ◽

10.1177/15266028211068759 ◽

2022 ◽

pp. 152660282110687

Author(s):

Peter-Lukas Haldenwang ◽

Mahmoud Elghannam ◽

Dirk Buchwald ◽

Justus Strauch

Keyword(s):

Digital Subtraction Angiography ◽

Subclavian Artery ◽

Cerebral Perfusion ◽

Left Subclavian Artery ◽

Circulatory Arrest ◽

False Lumen ◽

Distal Anastomosis ◽

Digital Subtraction ◽

Selective Cerebral Perfusion ◽

Elephant Trunk

Purpose: A hybrid aortic repair using the frozen elephant trunk (FET) technique with an open distal anastomosis in zone 2 and debranching of the left subclavian artery (LSA) has been demonstrated to be favorable and safe. Although a transposition of the LSA reduces the risk of cerebellar or medullar ischemia, this may be challenging in difficult LSA anatomies. Case Report: We present the case of a 61-year old patient with DeBakey I aortic dissection, treated with FET in moderate hypothermic circulatory arrest (26°C) and selective cerebral perfusion using a Thoraflex-Hybrid (Vascutek Terumo) prosthesis anchored in zone 2, with overstenting of the LSA orifice and no additional LSA debranching. Sufficient perfusion of the LSA was proved intraoperatively using LSA backflow analysis during selective cerebral perfusion in combination with on-site digital subtraction angiography (ARTIS Pheno syngo software). No neurologic dysfunction or ischemia occurred in the postoperative course. An angiographic computed tomography revealed physiologic LSA perfusion, with subsequent thrombotic occlusion of the false lumen in the proximal descending aorta after 7 days. Conclusion: Using an angiography-guided management in patients with complex DeBakey I dissection and difficult anatomy may simplify a proximalization of the distal anastomosis in zone 2 for FET, even without an additional LSA debranching.

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