Risk factor analysis of clinical outcomes of total aortic arch replacement and frozen elephant trunk with aortic balloon occlusion

Abstract Background Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 min, which increases the surgical risk. We invented an aortic balloon occlusion (ABO) technique that requires 5 min 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 ABO 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 in-hospital stay were also recorded. Results The 30-day mortality rates were similar between ABO group (4.6%) and conventional group (7.8%, P = 0.241). Multivariate analysis showed ABO 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 ABO achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay.

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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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Application of Aortic Balloon Occlusion in Total Aortic Arch Replacement with Frozen Elephant Trunk on Clinical Endpoints for Aortic Dissection Patients

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.oa.19-00288 ◽

2020 ◽

Vol 26 (6) ◽

pp. 332-341 ◽

Cited By ~ 1

Author(s):

Yunfeng Li ◽

Hongwei Guo ◽

Luchen Wang ◽

Shenghua Liang ◽

Xiaogang Sun

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Balloon Occlusion ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Clinical Endpoints ◽

Total Aortic Arch Replacement ◽

Aortic Balloon Occlusion

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

Journal of International Medical Research ◽

10.1177/0300060520905410 ◽

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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Improvement of Clinical Outcomes of Total Aortic Arch Replacement and Frozen Elephant Trunk Surgery With Aortic Balloon Occlusion

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.691615 ◽

2021 ◽

Vol 8 ◽

Author(s):

Luchen Wang ◽

Zeyi Cheng ◽

Yunfeng Li ◽

Junpeng Li ◽

Hongwei Guo ◽

...

Keyword(s):

Aortic Arch ◽

Clinical Outcomes ◽

Complication Rate ◽

Balloon Occlusion ◽

Conventional Approach ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Total Aortic Arch Replacement ◽

Aortic Balloon Occlusion

Background: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) surgery provides improved long-term results, but the surgery itself is associated with higher risks compared with isolated proximal reconstructions. We applied an aortic balloon occlusion (ABO) technique to reduce the circulatory arrest (CA) time and improve other clinical outcomes.Methods: All patients who underwent TAR with FET surgery (130 with ABO technique, 230 with the conventional approach) in Fuwai Hospital from August 2017 to February 2019 were reviewed in this retrospective observational cohort study. Intra- and early-postoperative results and clinical characteristics were analyzed.Results: After 1:1 propensity score matching (130 cases in each group), the 30-day mortality of the ABO group and the conventional group were 4.6% and 10.8% (p = 0.063), respectively. Although the reduction in complications was not statistically significant, the complication rate in the ABO group was relatively low, having fewer cases of postoperative renal (23.1 vs. 38.5%, p = 0.007) and hepatic (12.3 vs. 30.0%, p < 0.001) injury, lower postoperative wake-up time (15.2 ± 23.6 h vs. 20.1 ± 26.5 h, respectively, p < 0.001), reduced chest tube output (176.03 ± 143.73 ml vs. 213.29 ± 130.12 ml, respectively, p = 0.003), lower red blood cell transfusion volume (4.98 ± 6.53 u vs. 7.28 ± 10.41 u, respectively, p = 0.008), and no fatal events.Conclusions: The ABO technique is a simple method that can reduce the CA time and improve the recovery stage following TAR with FET surgery. The technique represents a practical strategy to treat patients with high operative risks due to its lower complication rate compared with the conventional approach.

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

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz229 ◽

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.

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