Using self -suture branching artificial vesssels in aortic arch surgery at Hanoi Heart Hospital

Background: For aortic arch surgery, the improvement of anastomosis technique, and the improvement of using self-suture branching artificial vessels have shortened the time and reduced the cost of surgery. The study aimed to evaluate the improved results of using self-suture branched artificial vessels in aortic arch surgery. Methods: A retrospective descriptive study of the use of self-suture branching artificial vessels in aortic arch surgery at Hanoi Heart Hospital from October 2018 to May 2021. Results: There were 33 cases of aortic arch replacement using self-suture branching artificial vessels. The rate of postoperative bleeding was 6.06%. The rate of artificial vessel infection is 0%. Conclusion: Using self-suture branching artificial vessels in aortic arch surgery is a safe and effective technique.

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Risks and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-center, Retrospective Cohort Study

10.21203/rs.3.rs-1220637/v1 ◽

2022 ◽

Author(s):

Ling Peng ◽

Dan Guo ◽

Yinhui Shi ◽

Jiapei Yang ◽

Wei Wei

Keyword(s):

Aortic Arch ◽

Cerebral Autoregulation ◽

Circulatory Arrest ◽

Cerebral Oximetry ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Aortic Arch Surgery ◽

Total Aortic Arch Replacement ◽

Independent Association ◽

New Onset

Abstract BackgroundImpairment of cerebral autoregulation (CA) has been observed in patients undergoing cardiopulmonary bypass (CPB), but little is known about its risks and associations with outcomes. The objective of this study was to analyze the risks of impaired CA, based on cerebral oximetry index (COx), in patients undergoing total aortic arch replacement with CPB and moderate hypothermic circulatory arrest (MHCA). We also evaluated the association between impaired CA and patient outcomes.MethodsOne hundred fifteen four adult patients who underwent total aortic arch replacement with stented elephant trunk implantation under CPB and MHCA at our hospital were retrospectively analyzed. Patients were defined as having new-onset impaired CA if post-CPB COx > 0.3, calculated based on a moving linear correlation coefficient between regional cerebral oxygen saturation (rScO2) and mean blood pressure (MAP). Pre- and intraoperative factors were tested for independent association with impaired CA. Postoperative outcomes were compared between patients with normal and impaired CA.ResultsIn our 154 patients, 46(29.9%) developed new-onset impaired CA after CPB with MHCA. Multivariate analysis revealed a prolonged low rScO2 (rScO2 <55%) independently associated with onset of impaired CA, and receiver operating charactoristic curve showed a cutoff value at 40 min (sensitivity, 89.5%; specificity, 68.0%). Compared with normal CA patients, those with impaired CA showed a significantly higher rates of in-hospital mortality and postoperative complications.ConclusionProlonged low rScO2 (rScO2 <55%) during aortic arch surgery was closely related to onset of impaired CA. Impaired CA remained associated with the increased rates of postoperative complications and in-hospital mortality.Trial registration: ChiCTR1800014545 with registered date 20/01/2018.

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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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