A Comparison of Frozen Elephant Trunk, Aortic Balloon Occlusion, and Hybrid Repair for Total Arch Replacement

2020 ◽  
Author(s):  
Shenghua Liang ◽  
Yanxiang Liu ◽  
Bowen Zhang ◽  
Yunfeng Li ◽  
Hongwei Guo ◽  
...  
Keyword(s):  
Balloon Occlusion ◽  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Balloon Occlusion ◽  
Hybrid Repair

scholarly journals The aortic balloon occlusion technique in total arch replacement with frozen elephant trunk

2018 ◽  
Vol 55 (6) ◽  
pp. 1219-1221 ◽  
Author(s):  
Xiaogang Sun ◽  
Hongwei Guo ◽  
Yanxiang Liu ◽  
Yunfeng Li
Keyword(s):  
Balloon Occlusion ◽  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Balloon Occlusion ◽  
Occlusion Technique ◽  
Balloon Occlusion Technique

Perfusion management of aortic balloon occlusion technique in total arch replacement with frozen elephant trunk

Perfusion ◽  
2019 ◽  
Vol 35 (4) ◽  
pp. 280-283
Author(s):  
Shujie Yan ◽  
Xiaogang Sun ◽  
Hongwei Guo ◽  
Yunfeng Li ◽  
Yu Zhao ◽  
...  
Keyword(s):  
Balloon Catheter ◽  
Balloon Occlusion ◽  
Total Arch Replacement ◽  
Lower Body ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Aortic Balloon Occlusion ◽  
Occlusion Technique ◽  
Balloon Occlusion Technique

To ensure both cerebral and lower body perfusion during total arch replacement with frozen elephant trunk, aortic balloon occlusion technique has been applied in some cases at our institute. During the procedure, after stented elephant trunk is inserted into the true lumen of the descending aorta, an aortic balloon catheter is placed and inflated within the stented elephant trunk, occluding the orifice of descending aorta. Then, lower body perfusion is provided via femoral cannulae during distal aortic arch anastomosis. We describe the perfusion management strategy of the technique, elucidate intraoperative monitoring parameters, and clarify the feasibility of the method from the aspect of perfusion.

scholarly journals Renal protective effect of the aortic balloon occlusion technique in total arch replacement with frozen elephant trunk

2020 ◽  
Vol 9 (3) ◽  
pp. 209-221
Author(s):  
Bowen Zhang ◽  
Yanxiang Liu ◽  
Hongwei Guo ◽  
Yunfeng Li ◽  
Yi Shi ◽  
...  
Keyword(s):  
Protective Effect ◽  
Balloon Occlusion ◽  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Balloon Occlusion ◽  
Occlusion Technique ◽  
Balloon Occlusion Technique

scholarly journals Risk Factor Analysis of Clinical Outcomes of Total Aortic Arch Replacement and Frozen Elephant Trunk With Aortic Balloon Occlusion

2021 ◽  
Author(s):  
Luchen Wang ◽  
Yunfeng Li ◽  
Yaojun Dun ◽  
Xiaogang Sun
Keyword(s):  
Hospital Stay ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Balloon Occlusion ◽  
Conventional Group ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Total Aortic Arch Replacement ◽  
Aortic Balloon Occlusion

Abstract Background: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 minutes, which increases the surgical risk. We invented an aortic balloon occlusion technique that requires 5 minutes of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study. Methods: This retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of aortic balloon occlusion group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during the in-hospital stay were also recorded. Results: The 30-day mortality rates were similar between the aortic balloon occlusion group (4.6%) and the conventional group (7.8%, P = 0.241). Multivariate analysis showed aortic balloon occlusion reduced postoperative acute kidney injury (23.1% vs 35.7%, P = 0.013) and hepatic injury (12.3% vs 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge. Conclusions: The aortic balloon occlusion achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay.

scholarly journals Early outcome of aortic balloon occlusion during total aortic arch replacement with the frozen elephant trunk technique for aortic dissection

2019 ◽  
Author(s):  
Yunfeng Li ◽  
Hongwei Guo ◽  
Yi Shi ◽  
Yanxiang Liu ◽  
Xiaogang Sun
Keyword(s):  
Stent Graft ◽  
Circulatory Arrest ◽  
Balloon Occlusion ◽  
Frozen Elephant Trunk ◽  
Selective Cerebral Perfusion ◽  
Elephant Trunk ◽  
Total Aortic Arch Replacement ◽  
Aortic Balloon Occlusion ◽  
Occlusion Technique ◽  
Antegrade Selective Cerebral Perfusion

Abstract OBJECTIVES The aim of this study was to propose and evaluate the new operative technique of aortic balloon occlusion in total aortic arch replacement (TAR) with the frozen elephant trunk that can significantly decrease the time of circulatory arrest and increase the hypothermic cardiopulmonary bypass (CPB) temperature. METHODS Between 2010 and 2018, 1335 patients with aortic dissection who underwent TAR with the frozen elephant trunk were included in the study. The newest 80 cases were treated with aortic balloon occlusion. To illustrate the difference with the new procedure, 1255 conventional TAR cases served as the historical control. Femoral and right axillary artery cannulations were used for CPB and antegrade selective cerebral perfusion. Circulatory arrest was implemented at the nasopharyngeal temperature of 28°C with continuous antegrade selective cerebral perfusion. After the stent graft was inserted into the true lumen of the descending aorta, the aortic balloon in a sheath was deployed into the stent graft and positioned at the metal part of the stent graft. When the balloon was inflated with enough saline to compress the stent graft, the sheath was simultaneously pressed by hand to properly fix the balloon and avoid displacement. Then femoral perfusion could be resumed. RESULTS The aortic balloon occlusion technique was successful in all patients, with the median duration of circulatory arrest being 5 (interquartile range 3–7) min. The 30-day mortality rate was 6.25% (5/80), whereas with the conventional method it was 9.40% (118/1255). The postoperative conscious revival (8.67 vs 11.40 h, P < 0.001) and mechanical ventilation times (19.70 vs 24.45 h, P = 0.02) were significantly shorter. Decreases in postoperative acute kidney injuries (13.75% vs 32.11%, P = 0.001) and liver injuries (8.75% vs 37.61%, P < 0.001) were also observed. The patients were transfused with lesser quantities of red blood cells, plasma and platelets. CONCLUSIONS The aortic balloon occlusion technique is a feasible way to shorten circulatory arrest significantly, to obviate the need for deep hypothermia in TAR with the frozen elephant trunk and to provide favourable protective effects on the central nervous, haematological and visceral systems. With these satisfactory results, this technique deserves further investigation.

scholarly journals Early Outcomes of Three Total Arch Replacement Strategies for DeBakey Type I Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Enzehua Xie ◽  
Jinlin Wu ◽  
Juntao Qiu ◽  
Lu Dai ◽  
Jiawei Qiu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Techniques ◽  
Operation Time ◽  
Balloon Occlusion ◽  
Total Arch Replacement ◽  
Type I ◽  
Elephant Trunk ◽  
Aortic Cross Clamp Time ◽  
Aortic Balloon Occlusion ◽  
Significant Difference

Background: This study employed three surgical techniques: total arch replacement (TAR) with frozen elephant trunk (FET), aortic balloon occlusion technique (ABO) and hybrid aortic arch repair (HAR) on patients with type I aortic dissection in Fuwai Hospital, aiming to compare the early outcomes of these surgical armamentariums.Methods: From January 2016 to December 2018, an overall 633 patients (431 of TAR+FET, 122 of HAR, and 80 of ABO) with type I aortic dissection were included in the study. Thirty-day mortality, stroke, paraplegia, re-exploration for bleeding, and renal replacement therapy were compared using the matching weight method (MWM).Results: After MWM process, the baseline characteristics were comparable among three TAR groups. It showed that ABO group had the longest cardiopulmonary bypass (p &lt; 0.001) and aortic cross-clamp time (p &lt; 0.001), while the operation time was longest in the HAR group (p = 0.039). There was no significant difference in 30-day mortality among groups (p = 0.783). Furthermore, the incidence of stroke (p = 0.679), paraplegia (p = 0.104), re-exploration for bleeding (p = 0.313), and CRRT (p = 0.834) demonstrated no significant difference. Of note, no significant differences were found regarding these outcomes even before using MWM.Conclusions: Based on the early outcomes, the three TAR approaches were equally applicable to type I aortic dissection. We may choose the specific procedure relatively flexibly according to patient status and surgeon's expertise. Importantly, long-term investigations are warranted to determine whether above approaches remain to be of equivalent efficacy and safety.

scholarly journals The strategy of cardiopulmonary bypass for total aortic arch replacement and the frozen elephant trunk technique with aortic balloon occlusion

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052090541
Author(s):  
Yunfeng Li ◽  
Shujie Yan ◽  
Song Lou ◽  
Xiaogang Sun
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Arch ◽  
Balloon Occlusion ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Total Aortic Arch Replacement ◽  
Aortic Balloon Occlusion ◽  
Occlusion Technique ◽  
Balloon Occlusion Technique

Objective To investigate the use of the aortic balloon occlusion technique to assist total aortic arch replacement (TAR) with frozen elephant trunk (FET) to shorten the lower body circulatory arrest (CA) time and raise the nadir temperature during cardiopulmonary bypass. Methods This retrospective study reviewed consecutive patients that underwent aortic balloon occlusion to assist TAR with FET and patients that received conventional TAR with FET procedures. Preoperative characteristics, perioperative characteristics and postoperative outcomes were compared between the two groups. Results The study included130 patients treated with aortic balloon occlusion and 230 patients treated with conventional TAR with FET. The 30-day mortality rate was similar between the aortic balloon occlusion and conventional groups (4.62% versus 7.83%, respectively). Multivariate analysis showed that aortic balloon occlusion reduced the incidence of acute kidney injury, hepatic injury and red blood cell transfusion. The application of aortic balloon occlusion reduced the mean ± SD CA time from 17.24 ± 4.36 min to 6.33 ± 5.74 min, with the target nadir nasal temperature being increased from 25°C to 28°C. Conclusion The aortic balloon occlusion technique achieved significant improvements in reducing complications, but this did not translate into lower 30-day mortality.

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