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 < 0.001) and aortic cross-clamp time (p < 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 Total Arch Replacement with Stented Elephant Trunk in DeBakey Type I Acute Aortic Dissection

2013 ◽  
Vol 46 (1) ◽  
pp. 68-71 ◽  
Author(s):  
Hyung-Yoon Choi ◽  
Suk-Won Song ◽  
Sun-Chang Hong ◽  
Sun-Hee Lim, R.N.
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Total Arch Replacement ◽  
Type I ◽  
Elephant Trunk

scholarly journals Early outcomes of hybrid type II arch repair versus total arch replacement with frozen elephant trunk in acute DeBakey type I aortic dissection: a propensity score-matched analysis

2020 ◽  
Vol 31 (4) ◽  
pp. 565-572
Author(s):  
Yanxiang Liu ◽  
Shenghua Liang ◽  
Bowen Zhang ◽  
Yunfeng Li ◽  
Lucheng Wang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aortic Dissection ◽  
Protective Factor ◽  
Total Arch Replacement ◽  
Type I ◽  
Type Ii ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Low Cardiac Output Syndrome ◽  
Hybrid Type

Abstract OBJECTIVES The aim was to evaluate the short-term outcomes of hybrid type II arch repair (HAR) and total arch replacement with frozen elephant trunk (TAR with FET) for acute DeBakey type I aortic dissection patients. METHODS From January 2017 to June 2019, the clinical data of acute DeBakey type I aortic dissection patients in a single centre were retrospectively reviewed; there were 92 cases of HAR and 268 cases of TAR with FET, with 56 pairs by propensity score matching. RESULTS After matching, the composite end points including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome were comparable (21.4%, 12/56 in the HAR group vs 21.4%, 12/56 in the TAR with FET group, P = 1.000). The rate of acute kidney injury (AKI) was significantly lower in the HAR group (58.9%, 33/56 vs 80.4%, 45/56, P = 0.031). The distribution of AKI stage according to the Kidney Disease Improving Global Outcomes criteria was different (P = 0.039), with more patients suffering from high-grade AKI in the TAR with FET group. Multivariable logistic analysis showed that the procedure type (HAR or TAR with FET) was not an independent predictor of composite adverse events or stroke. HAR was identified as a protective factor against AKI (odds ratio 0.485, 95% confidence interval 0.287–0.822; P = 0.007). CONCLUSIONS In the treatment of acute DeBakey type I aortic dissection, no significant differences were found in early outcomes between the 2 groups, but HAR was associated with a significantly lower incidence of AKI.

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 Proximalized Total Arch Replacement Can Be Safely Performed by Trainee

2020 ◽  
Author(s):  
Sentaro Nakanishi ◽  
Naohiro Wakabayashi ◽  
Hayato Ise ◽  
Hiroto Kitahara ◽  
Aina Hirofuji ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Operation Time ◽  
Patient Characteristics ◽  
Total Arch Replacement ◽  
Elephant Trunk ◽  
Entire Cohort ◽  
Experience Levels ◽  
Concomitant Surgery ◽  
Significant Difference ◽  
Group A

Abstract Background The aim of the present study was to validate safety of total arch replacement (TAR) using a novel frozen elephant trunk device, operated by trainees as surgical education. Methods Sixty-four patients including 19 patients (29.6%) with acute aortic dissection type A (AADA) underwent TAR in our institute between April 2014 and March 2019 were retrospectively analyzed. Twenty-nine patients were operated by trainees (group T) and 35 patients were operated by attending surgeons (group A). Results Patient characteristics did not differ between groups. Operative time (409.4 ± 87.8 vs. 468.6 ± 129.6 minutes, p = 0.034), cardiopulmonary bypass time (177.7 ± 50.4 vs. 222.9 ± 596.7 minutes, p = 0.019), and hypothermic circulatory arrest time (39.5 ± 13.4 vs. 54.5 ± 18.5 minutes, p = 0.001) were significantly shorter in group A than in group T, but aortic clamping time did not differ between groups (115.3 ± 55.7 vs. 114.2 ± 35.0 minutes, p = 0.924) because the rate of concomitant surgery was higher in group A (37.1 vs. 10.3%, p = 0.014). Thirty-day mortality was 3.1% in the entire cohort. Although operation time was longer in group T, there were no significant difference in postoperative results between the groups, and the experience levels of the main operator were not independent predictors for in-hospital mortality + major postoperative complications. There was no difference in late death and aortic events between groups. Conclusions The present study demonstrated that TAR can be safely performed by trainees, and suggests TAR as a possible and safe educational operation.

scholarly journals Body mass index is an independent predictor of acute kidney injury after urgent aortic arch surgery for acute DeBakey Type I aortic dissection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Taoshuai Liu ◽  
Yuwei Fu ◽  
Jie Liu ◽  
Yongmin Liu ◽  
Junming Zhu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Acute Kidney Injury ◽  
Aortic Dissection ◽  
Body Mass ◽  
Independent Predictor ◽  
Kidney Injury ◽  
Total Arch Replacement ◽  
Type I ◽  
Elephant Trunk ◽  
Replacement Surgery

Abstract Background Aortic arch surgery and obesity are both related to the risk of acute kidney injury. Our hypothesis was that the risk of postoperative acute kidney injury increases as body mass index increases in patients undergoing urgent aortic total arch replacement surgery for acute DeBakey Type I aortic dissection. Methods We conducted a retrospective cohort study in Beijing Anzhen Hospital from December 2015 to April 2017. All patients receiving urgent aortic total arch replacement surgery with a frozen elephant trunk implant for acute DeBakey Type I aortic dissection were included. Body mass index was calculated based on height and weight. Acute kidney injury was diagnosed based on the Kidney Disease Improving Global Outcomes standards. Results We included 115 consecutive patients in this study. A total of 53.0% (n = 61) of patients had acute kidney injury. The mean age was 47.8 ± 10.7 years, and 25.2% were women. Mean body mass index was 26.2 ± 3.9 kg/m2. The results of a univariate analysis showed that BMI, eGFR, CPB time, operative time, intraoperative blood loss, intraoperative amount of PRBCs, and respiratory failure were significantly correlated with AKI. In-hospital mortality was obviously increased in the acute kidney injury group (13.1% vs 1.9%; P = 0.025). Multivariate logistic regression showed that body mass index was associated with postoperative acute kidney injury after adjusting for other confounding factors (odds ratio = 1.16; 95% confidence interval: 1.02–1.33; P = 0.0288). The risk of postoperative AKI in the BMI ≥ 24 kg/m2 group was increased by 2.35 times (OR = 3.35, 95% CI: 1.15–9.74; p = 0.0263). Conclusions Body mass index was an independent predictor of acute kidney injury after urgent aortic total arch replacement surgery with a frozen elephant trunk implant.

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