Rapid Novel Aortic Arch Replacement for Thoracic Aortic Aneurysm                     Using Three Continuous Sutures and a Felt Cylindrical Collar

This report describes the novel parachute technique of open distal anastomosis at the aortic arch replacement. Two Teflon felt cylindrical collars were initially placed on the anastomotic site of the descending aorta. All four to five outer loops of the stitches used in the parachute technique were tracked by the gathering suture. The anastomotic sutures and three gathering sutures were finally pulled simultaneously. The prosthetic graft and the aortic stump with Teflon felt were safely and completely anastomosed. Surgical or hospital death and serious complications were not found. The mean anastomotic duration (circulatory arrest duration) in 16 patients was 23 minutes. Our novel technique using a Teflon felt cylindrical collar and modified continuous suturing was not only safe but also reduced the duration of anastomosis and minimized blood loss. This technique is simple and can be applied to aortic valve replacement.

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Early Results of a Novel Single-Stage Hybrid Aortic Arch Replacement Technique to Reduce Bypass and Circulatory Arrest Duration

The Heart Surgery Forum ◽

10.1532/hsf.2831 ◽

2020 ◽

Vol 23 (2) ◽

pp. E107-E113

Author(s):

Castigliano Murthy Bhamidipati ◽

Jay D Pal

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Dissection ◽

Aortic Arch ◽

Stent Graft ◽

Circulatory Arrest ◽

True Lumen ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Descending Aorta ◽

The Mean

ABSTRACT Objective: Hybrid repair procedures of the aortic arch have been utilized to reduce surgical risks and apply this therapy to patients who would not traditionally be candidates for open surgical repair. We present a variation on the frozen elephant trunk technique to further reduce cardiopulmonary bypass and circulatory arrest duration. Methods: After initiation of cardiopulmonary bypass and during systemic cooling, a wire is advanced from the femoral artery into the aortic arch. In the case of aortic dissection, intravascular ultrasound is used to confirm true lumen placement. Under circulatory arrest, the proximal aortic arch is resected and the wire externalized. Antegrade deployment of a stent graft is performed into the aortic arch and proximal descending aorta. The ascending aortic graft is sewn to the cut end of the aorta, incorporating the stent graft. The graft is cannulated and cardiopulmonary bypass reinitiated. The remainder of the arch replacement is performed during re-warming. Results: Twenty two patients underwent this novel hybrid arch replacement procedure for aortic pseudoaneurysm, aortic dissection, or aneurysm. In comparison to the frozen elephant trunk procedure, where a dacron graft is inserted into the descending aorta, and later fixed with an endograft, this technique allows for immediate distal fixation. In the case of aortic dissection, there is immediate expansion of the true lumen with distal seal, potentially obviating the need for additional procedures. Mean duration of follow up is 12 months (range 1 – 14 months). The mean duration of cardiopulmonary bypass was 109.32 ±3.14 minutes. The mean duration of circulatory arrest was 18.00 ±1.33 minutes at a mean temperature of 23.64 ±0.58 degrees Celsius. There were no mortalities, no permanent disabling strokes, and no renal failure (requiring dialysis). Conclusions: This novel hybrid technique for aortic arch replacement is safe, significantly reduces cardiopulmonary bypass and circulatory arrest times, and is performed readily without need for fluoroscopy. In patients with thoracoabdominal aneurysms, the stent graft can be used as an elephant trunk for further thoracoabdominal aneurysm repair or branched thoracic endovascular aortic repair procedures.

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Severe systemic inflammatory response syndrome in patients following Total aortic arch replacement with deep hypothermic circulatory arrest

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-1027-3 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Jun Li ◽

Lijing Yang ◽

Guyan Wang ◽

Yuefu Wang ◽

Chunrong Wang ◽

...

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Aortic Arch ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Systemic Inflammatory Response ◽

Hospital Death ◽

Aortic Arch Replacement ◽

Total Aortic Arch Replacement

Abstract Background This cohort study aims to retrospectively investigate the incidence of severe systemic inflammatory response syndrome (sSIRS) in patients following total aortic arch replacement (TAR) under deep hypothermic circulatory arrest (DHCA) with selective cerebral perfusion and its effect on clinical outcomes. Methods All patients who underwent TAR with DHCA were consecutively enrolled from January 2013 until December 2015 at our institute. sSIRS was diagnosed between 12 and 48 h postoperatively if patients met all four criteria of the SIRS definition. Results Of the 522 patients undergoing TAR with DHCA, 31.4% developed sSIRS. Patients aged under 60 yr were characterized by a higher prevalence of sSIRS (OR = 2.93; 95% CI 2.01–4.28; P <0.001). Higher baseline serum creatinine (OR = 1.61; 95% CI 1.18–2.20; P = 0.003), concomitant coronary disease (OR = 2.00; 95% CI 1.15–3.48; P = 0.015) and extended cardiopulmonary time (OR = 1.63; 95% CI 1.23–2.18; P = 0.001) independently contributed to a greater likelihood of postoperative sSIRS onset, while the preferred administration of ulinastatin (OR = 0.69; 95% CI 0.51–0.93; P = 0.015) and dexmedetomidine (OR = 0.36; 95% CI 0.23–0.56; P < 0.001) attenuated it. Patients with sSIRS had a greater risk of developing postoperative major adverse complications compared with the no sSIRS group [56.7%(93/164) vs 26.8% (96/358), P < 0.001]. sSIRS was found to be a significant risk factor for major adverse complications (OR, 4.52; 95% CI, 3.40–6.01; P < 0.001). A significant difference was revealed in in-hospital death following TAR between the sSIRS group and the no-sSIRS group [4.88% (8/164) vs 1.12% (4/358), P = 0.019]. The Kaplan-Meier curve indicated that the time to discharge from the intensive care unit was significantly prolonged in the sSIRS group compared with patients without it (log-rank p < 0.001). Conclusions sSIRS occurs commonly in patients following TAR with DHCA. There is an inverse association between age and sSIRS onset, whereby age over 60 yr can lower the risk of it. sSIRS development can increase the likelihood of major postoperative major adverse events.

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Right cervical aortic arch with aneurysm and stenotic tract of left descending aorta and aberrant left subclavian artery: case report of a 13-years-old patient

10.22541/au.163690585.57531965/v1 ◽

2021 ◽

Author(s):

Carlo Pace Napoleone ◽

Luca Deorsola ◽

Isabella Molinari ◽

Francesca Ferroni ◽

Roberto Tumbarello

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Pediatric Population ◽

Circulatory Arrest ◽

Prosthetic Graft ◽

Safe Alternative ◽

Case Presentation ◽

Descending Aorta ◽

Alternative Approach ◽

The Right

Background: Cervical aortic arch (CAA) is a rare anomaly that could be associated with aortic stenosis, aneurysm or heart malformations. To correct this anomaly, symptomatic patients undergo surgery, usually consisting of a prosthetic graft repair. Moreover, circulatory arrest and deep hypothermia are often needed. Case presentation: A 13-years-old patient underwent correction of an aortic arch stenosis with a post-stenotic aneurysm between the origin of the right carotid artery (RCA) and right subclavian artery (RSA) in a right CAA. A resection with direct end-to-end anastomosis was performed, with mild hypothermic cardiopulmonary by-pass. Conclusions: Surgical correction of cervical aortic arch anomalies without the use of prosthetic grafts and circulatory arrest may be a safe alternative approach, especially in the pediatric population.

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EndoClamp Aortic Catheter in the descending aorta for normothermic aortic arch replacement on the beating heart without circulatory arrest

Perfusion ◽

10.1177/0267659113486509 ◽

2013 ◽

Vol 28 (5) ◽

pp. 453-456 ◽

Cited By ~ 3

Author(s):

M Di Natale ◽

F Tancredi ◽

V Bachicchio ◽

G Paternoster ◽

S Lentini

Keyword(s):

Aortic Arch ◽

Circulatory Arrest ◽

Beating Heart ◽

Aortic Arch Replacement ◽

Descending Aorta

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Successful use of one dose of recombinant factor VIIa to control severe bleeding after emergency aortic arch replacement in deep hypothermic circulatory arrest

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2004.03.018 ◽

2004 ◽

Vol 128 (6) ◽

pp. 941-943 ◽

Cited By ~ 2

Author(s):

Christoph Wiesenack ◽

Matthias Arlt ◽

Andreas Liebold ◽

Franz X. Schmid

Keyword(s):

Aortic Arch ◽

Recombinant Factor Viia ◽

Factor Viia ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Severe Bleeding ◽

Aortic Arch Replacement

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

10.21203/rs.3.rs-554555/v1 ◽

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.

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