Total aortic arch replacement without deep hypothermic circulatory arrest in type A aortic dissection: Left axillar artery for arterial cannulation

被引:2
作者
Kiziltepe, Ugursay [1 ,2 ]
Ince, Ilker [1 ]
Senkal, Melike [1 ]
Surer, Suleyman [1 ]
Duvan, Ibrahim [1 ]
Ersoy, Ozgur [1 ]
Delibalta, Omer [1 ]
Mavi, Osman [1 ]
Sahin, Elif [1 ]
机构
[1] Hlth Sci Univ, Diskapi Yildirim Beyazit Training & Res Hosp, Dept Cardiovasc Surg, Ankara, Turkiye
[2] Diskapi YBEA Hosp, Dept Cardiovasc Surg, Sht Omer Halisdemir Blvd 20, TR-06600 Ankara, Turkiye
关键词
total arch replacement; frozen elephant trunk; type A aortic dissection; circulatory arrest; deep hypothermia; left axillary artery cannulation; FROZEN ELEPHANT TRUNK; GERMAN REGISTRY; PERFUSION; REPAIR;
D O I
10.1016/j.xjtc.2023.08.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Total aortic arch replacement (TAR) necessitates hypothermic circulatory arrest (CA). The frozen elephant trunk technique (FET) additionally requires commercial hybrid grafts. Herein we describe a novel modified FET technique without CA using standard grafts thanks to left axillary artery (LAxA) cannulation in patients with acute type A aortic dissection.Methods: LAxA anastomosis is made first using a homemade debranching graft, and cardiopulmonary bypass is initiated, followed by anastomoses of left common carotid and innominate arteries. The rest of the operation is performed with complete cerebral perfusion. Following replacement of ascending aorta/root, cardiac re -perfusion is started using a root cannula which continues throughout the procedure. Distal arch anastomosis is performed clamp-on, allowing lower body perfusion via left subclavian artery. Lower body perfusion is interrupted for 5 to 8 minutes to deploy an endograft to complete a modified FET. Following cannulation of distal arch graft, perfusion of distal aorta is restarted, and all three grafts are incorporated to construct a neo-ascending aorta and arch.Results: Between December 2018 and May 2022, 38 patients underwent TAR without operative mortality. Hospital mortality was %15.7, and spinal cord ischemia and stroke were not encountered in surviving patients. The mean lower body CA time was 7.2 +/- 2.8 minutes.Conclusions: TAR using standard endografts without CA is possible with LAxA cannulation. To perform a FET, only a short interruption of lower body circulation is sufficient to deploy an endograft, also improving hemostasis of distal anastomosis. Further studies are required with a higher number of patients to evaluate the efficiency of this novel technique.
引用
收藏
页码:120 / 131
页数:12
相关论文
共 24 条
[1]   Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA) [J].
Conzelmann, Lars Oliver ;
Weigang, Ernst ;
Mehlhorn, Uwe ;
Abugameh, Ahmad ;
Hoffmann, Isabell ;
Blettner, Maria ;
Etz, Christian D. ;
Czerny, Martin ;
Vahl, Christian F. .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2016, 49 (02) :e44-e52
[2]   Technical details making aortic arch replacement a safe procedure using the Thoraflex™ Hybrid prosthesis [J].
Czerny, Martin ;
Rylski, Bartosz ;
Kari, Fabian A. ;
Kreibich, Maximilian ;
Morlock, Julia ;
Scheumann, Johannes ;
Kondov, Stoyan ;
Suedkamp, Michael ;
Siepe, Matthias ;
Beyersdorf, Friedhelm .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2017, 51 :15-19
[3]   Safety and pitfalls in frozen elephant trunk implantation [J].
Damberg, Anneke ;
Schaelte, Gereon ;
Autschbach, Ruediger ;
Hoffman, Andras .
ANNALS OF CARDIOTHORACIC SURGERY, 2013, 2 (05) :669-676
[4]   Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection - analysis of the German Registry for Acute Aortic Dissection type A (GERAADA) [J].
Easo, Jerry ;
Weigang, Ernst ;
Hoelzl, Philipp P. F. ;
Horst, Michael ;
Hoffmann, Isabell ;
Blettner, Maria ;
Dapunt, Otto E. .
ANNALS OF CARDIOTHORACIC SURGERY, 2013, 2 (02) :175-180
[5]   Comparison of attachment site endoleak rates in Dacron versus native aorta landing zones after thoracic endovascular aortic repair [J].
Ganapathi, Asvin M. ;
Andersen, Nicholas D. ;
Hanna, Jennifer M. ;
Gaca, Jeffrey G. ;
McCann, Richard L. ;
Hughes, G. Chad .
JOURNAL OF VASCULAR SURGERY, 2014, 59 (04) :921-929
[6]   Aortic Arch Reconstructive Surgery With Conventional Techniques vs Frozen Elephant Trunk: A Systematic Review and Meta-Analysis [J].
Hanif, Hasib ;
Dubois, Luc ;
Ouzounian, Maral ;
Peterson, Mark D. ;
El-Hamamsy, Ismail ;
Dagenais, Francois ;
Hassan, Ansar ;
Chu, Michael W. A. .
CANADIAN JOURNAL OF CARDIOLOGY, 2018, 34 (03) :262-273
[7]  
Hemli JM, 2018, INNOVATIONS, V13, P70, DOI 10.1097/IMI.0000000000000459
[8]   2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease [J].
Isselbacher, Eric M. ;
Preventza, Ourania ;
Black, James Hamilton, III ;
Augoustides, John G. ;
Beck, Adam W. ;
Bolen, Michael A. ;
Braverman, Alan C. ;
Bray, Bruce E. ;
Brown-Zimmerman, Maya M. ;
Chen, Edward P. ;
Collins, Tyrone J. ;
DeAnda, Abe, Jr. ;
Fanola, Christina L. ;
Girardi, Leonard N. ;
Hicks, Caitlin W. ;
Hui, Dawn S. ;
Jones, William Schuyler ;
Kalahasti, Vidyasagar ;
Kim, Karen M. ;
Milewicz, Dianna M. ;
Oderich, Gustavo S. ;
Ogbechie, Laura ;
Promes, Susan B. ;
Ross, Elsie Gyang ;
Schermerhorn, Marc L. ;
Times, Sabrina Singleton ;
Tseng, Elaine E. ;
Wang, Grace J. ;
Woo, Y. Joseph .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2022, 80 (24) :E223-E393
[9]   Clinical Cerebrovascular Anatomy [J].
Krishnaswamy, Amar ;
Klein, Joshua P. ;
Kapadia, Samir R. .
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2010, 75 (04) :530-539
[10]   INTRALUMINAL BYPASS OF ABDOMINAL AORTIC-ANEURYSM - FEASIBILITY STUDY [J].
LABORDE, JC ;
PARODI, JC ;
CLEM, MF ;
TIO, FO ;
BARONE, HD ;
RIVERA, FJ ;
ENCARNACION, CE ;
PALMAZ, JC .
RADIOLOGY, 1992, 184 (01) :185-190