Preliminary results of single centre experience with the “release and perfuse technique” during aortic arch surgery.

Background and aim of the study To evaluate whether the release and perfuse technique implies a circulatory arrest time comparable with or shorter than those of standard Frozen Elephant Trunk technique in aortic arch surgery. Methods We retrospectively reviewed the records of patients who had undergone aortic arch repair with Release and Perfuse Technique (RPT) or standard Frozen Elephant Trunk (FET) at our Institution between January 2018 and May 2021. Primary endpoints were the comparison of circulatory arrest time, perioperative variables, and complications between two groups. A propensity score weighting approach was used for data analysis. Results A total of 41 patients underwent aortic arch surgery were analyzed:15 (37%) and 26 (63 %) in RPT and FET group, respectively. The use of RPT showed a significant shorter circulatory arrest times than FET: 9 min vs 58 min (P < 0.001), respectively. The median lactates peak in the first 24h post intervention was 2.6 for RPT group and 5.4 mmol/L for FET group, (P <0.0001). When compared with the FET, RPT is associated with significant reduction in the use of packed red blood cells (P <0.0001), fresh frozen plasma (P <0.0001), platelet concentrate (P <0.0001), and fibrinogen (P <0.004). The median ICU stay was 3 and 9 days (P = 0.011), whereas the median hospital stay was 12 and 18.5 days (P=0.004) in the RPT and FET groups, respectively. Thirty-day mortality and postoperative outcomes were comparable between the two groups. Conclusions Considering the anatomical limitations related to the use of this technique, the RPT appears to be safe, feasible, and effective in reducing the circulatory arrest time during aortic arch surgery. Nevertheless, further studies are required to demonstrate its safety and efficacy.

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Correlation of Coagulopathy and Frozen Elephant Trunk Use in Aortic Arch Surgery: A Systematic Review and Meta-analysis

10.22541/au.163256786.62395603/v1 ◽

2021 ◽

Author(s):

Mohamad Bashir ◽

Hadi Abo Aljadayel ◽

Mostafa Mousavizadeh ◽

Mahdi Daliri ◽

Yousef Rezaei ◽

...

Keyword(s):

Systematic Review ◽

Aortic Arch ◽

Meta Analysis ◽

Postoperative Bleeding ◽

Fresh Frozen Plasma ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Surgery ◽

Stent Type ◽

Fresh Frozen

Background: The advent of Frozen elephant trunk (FET) for reconstruction of elective and non-elective aortic arch surgery has augmented the treatment of complex aortic pathologies in a single-stage operation. To date, no studies have been focused on the prevalence and predictors of coagulopathy potentiated by FET procedure. Methods: In a systematic review, we searched databases up to June 2020 for studies reporting coagulopathy complications after FET procedure. A proportional meta-analysis was carried out using STATA software (StataCorp, TX, USA). Results: In total, 46 studies including 6313 patients were eligible. The pooled estimation of reoperation for postoperative bleeding was 7% (95% confidence interval [CI] 5 to 8; I2 = 84.73%; reported by 39 studies including 4796 patients). The mean volume of transfused packed blood cells and fresh frozen plasma was 1677 ml (95% CI 1066.4-2287.6) and 1016.5 ml (95% CI 450.7-1582.3). The subgroup by stent type showed a decrease in the heterogeneity (I2 = 0.01%, I2 = 53.95%, I2 = 0.01%, and I2 = 54.41% for Thoraflex® Hybrid, E-vita®, Frozenix®, and Cronus®, respectively). The subgroup by chronicity of operation resulted in less heterogeneity among patients undergoing elective compared to non-elective operation (I2 = 29.22% versus I2 = 80.56% in non-elective). Meta-regression analysis showed that age and male gender significantly impacted on the reoperation for postoperative bleeding. Conclusions: The FET procedure for arch replacement is associated with coagulopathy and the transfusion of blood products. Male, age, and selective choice of FET use were identified as heterogeneity sources of reoperation for postoperative bleeding.

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A simplified delivery frozen elephant trunk technique to reduce circulatory arrest time in hybrid aortic arch surgery

Journal of Cardiac Surgery ◽

10.1111/jocs.15708 ◽

2021 ◽

Author(s):

Thomas Sénage ◽

Nicolas Bonnet ◽

Guillaume Guimbretière ◽

Charles‐Henri David ◽

Jean‐Christian Roussel ◽

...

Keyword(s):

Aortic Arch ◽

Circulatory Arrest ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Surgery ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

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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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Different aortic arch surgery methods for type A aortic dissection: clinical outcomes and follow-up results

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa095 ◽

2020 ◽

Vol 31 (2) ◽

pp. 254-262

Author(s):

Yunxing Xue ◽

Jun Pan ◽

Hailong Cao ◽

Fudong Fan ◽

Xuan Luo ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Clinical Outcomes ◽

Type A ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Type A Aortic Dissection ◽

Aortic Arch Surgery

Abstract OBJECTIVES The aim of this study was to investigate the clinical outcomes and follow-up results among 5 main aortic arch surgery methods for type A aortic dissection in a single centre. METHODS From 2002 to 2018, 958 type A aortic dissection patients who received surgical repair were divided into 5 groups according to the arch surgery method: hemiarch replacement (n = 206), island arch replacement (n = 54), total arch replacement with frozen elephant trunk (n = 425), triple-branched stent (n = 39) and fenestrated stent (n = 234). The indications for the different arch methods were related to the patient’s preoperative status, the location and extent of the dissection and the surgical ability of the surgeons. A comparative study was performed to identify the differences in the perioperative data, and the Kaplan–Meier analysis was used to assess the long-term survival and reintervention rates. Thirty matched surviving patients that were included in each group completed Computed tomography angiography to determine long-term reshaping effect. RESULTS The 30-day mortality rate was 15.8%, and there was no difference among the 5 groups (P = 0.848). The follow-up survival rates were similar among the 5 groups (P = 0.130), and the same was true for patients without reintervention (P = 0.471). In the propensity matching study, patients with stents (frozen elephant trunk, triple-branched stent, fenestrated stent) had a slower aortic dilation rate and a higher ratio of thrombosis in the false lumen at the descending aortic and abdominal aortic levels than patients without stents. CONCLUSIONS No standard method is available for arch surgery, and indications and long-term effects should be identified with clinical data. In our experiences, simpler surgical procedures could reduce mortality in critically ill patients and stents in the distal aorta could improve long-term reshape effects.

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Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezv484 ◽

2016 ◽

Vol 50 (1) ◽

pp. 140-144 ◽

Cited By ~ 13

Author(s):

Ali El-Sayed Ahmad ◽

Petar Risteski ◽

Nestoras Papadopoulos ◽

Medhat Radwan ◽

Anton Moritz ◽

...

Keyword(s):

Minimally Invasive ◽

Aortic Arch ◽

Frozen Elephant Trunk ◽

Minimally Invasive Approach ◽

Elephant Trunk ◽

Invasive Approach ◽

Aortic Arch Surgery ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

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Outcomes of Concomitant Frozen Elephant Trunk (FET) in Aortic Arch Surgery in a Specialised Aortic Centre

Structural Heart ◽

10.1080/24748706.2020.1714322 ◽

2020 ◽

Vol 4 (sup1) ◽

pp. 127-128

Author(s):

Saleem Muhammad Jahangeer ◽

Shahd Mobarak ◽

Ijas Moideen ◽

Akbar Vohra ◽

Ragheb Hasan ◽

...

Keyword(s):

Aortic Arch ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Surgery

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Re: Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezv464 ◽

2016 ◽

Vol 50 (1) ◽

pp. 145-145

Author(s):

Martin Czerny

Keyword(s):

Minimally Invasive ◽

Aortic Arch ◽

Frozen Elephant Trunk ◽

Minimally Invasive Approach ◽

Elephant Trunk ◽

Invasive Approach ◽

Aortic Arch Surgery ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

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Moderate Hypothermic Circulatory Arrest (≥ 28°C) with Selective Antegrade Cerebral Perfusion for Total Arch Replacement with Frozen Elephant Trunk Technique

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1639478 ◽

2018 ◽

Vol 67 (05) ◽

pp. 345-350 ◽

Cited By ~ 2

Author(s):

Ali El-Sayed Ahmad ◽

Petar Risteski ◽

Mahmut Ay ◽

Nestoras Papadopoulos ◽

Anton Moritz ◽

...

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Total Arch Replacement ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Cord Injury ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion

Objectives The optimal hypothermic level during circulatory arrest in aortic arch surgery remains controversial, particularly in frozen elephant trunk (FET) procedures. We describe herein our experience for total arch replacement with FET technique under moderate systemic hypothermic circulatory arrest (≥ 28°C) during selective antegrade cerebral perfusion. Methods Between January 2009 and January 2016, 38 consecutive patients underwent elective total arch replacement for various aortic arch pathologies with FET technique using the E-vita Open hybrid prosthesis (Jotec GmbH, Hechingen, Germany). Selective unilateral or bilateral cerebral perfusion under moderate systemic hypothermic circulatory arrest (28.7°C ± 0.5°C) was used in all patients. Minimally invasive total arch replacement with FET via partial upper sternotomy was performed in 15 patients (39%) and in the remaining 23 patients (61%) via full sternotomy. Mean late follow-up was 3 ± 2 years and was 98% complete. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass time accounted for 198 ± 58 minutes and the myocardial ischemic time 109 ± 29 minutes. Selective antegrade cerebral perfusion time was 55 ± 6 minutes. Lower body circulatory arrest time was 39 ± 11 minutes. Unilateral cerebral perfusion was performed in 31 patients (82%), and bilateral in 7 patients (18%). Intensive care unit stay was 4 ± 3 days. Thirty-day mortality was 5% (n = 2). Late survival at 3 years was 87 ± 3%. Two patients (5%) required reexploration for bleeding. Patients were discharged after a hospital length of stay of 7 ± 2 days. Postoperative permanent neurologic complication occurred in two patients (5%). Three patients (8%) experienced a transient neurologic disorder. New transient renal replacement therapy was necessary in three patients (8%). No spinal cord injury was noted. Conclusions Our data suggest that moderate systemic hypothermic circulatory arrest (≥ 28°C) in combination with antegrade cerebral perfusion can safely be applied for total aortic arch replacement with FET and offers sufficient neurologic and visceral organ protection.

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