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

Sénage, Thomas; Bonnet, Nicolas; Guimbretière, Guillaume; David, Charles-Henri; Roussel, Jean‐Christian; Braunberger, Éric

doi:10.1111/jocs.15708

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…This seems promising, and it represents the last effort of the surgical community to resolve the problem of circulatory arrest time during aortic arch surgery. 13,19 Similar to the RPT, Senage et al 20 have recently described modified FET technique in which the lower body reperfusion precedes the distal anastomosis. Despite some technical differences (i.e., the proximalization of the distal anastomosis and the use of two tourniquets to avoid backflow on the operative field) this approach appears to be feasible in specific anatomic settings.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of the “release and perfuse technique” for aortic arch surgery

Piperata

D’Ostrevy

Busuttil

et al. 2022

Journal of Cardiac Surgery

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Objectives:The hypothermic circulatory arrest is a major limitation of the frozen elephant trunk (FET) technique, associated with a high incidence of postoperative mobility and mortality. The aim of this study was to evaluate the surgical outcomes of patients suffering from different aortic arch diseases treated with the release and perfuse technique (RPT).Methods: We retrospectively reviewed the records of patients who had undergone aortic arch repair with the RPT at our Institution between October 2019 and September 2021. Preoperative, intra-operative, and postoperative data were collected.Results: A total of 18 patients undergoing aortic arch surgery with the use of RPT were analyzed. Twelve of them (67%) were males, and the median age of the entire cohort was 67 (56-73) years. The primary indications for surgery included acute type A aortic dissection (50%), chronic type B aortic dissection (33%), and chronic aneurysms (17%). The median cardiopulmonary bypass-, aortic cross-clamp-and circulatory arrest times were 163 (147-213) min, 69 (51-120) min, and 10 (8-13) min, respectively. The median intensive care unit and hospital stay were 4(2-7) and 12 (11-16) days, respectively. One patient (6%) died during the first 30 days after surgery.Conclusions: Considering the anatomical limitations related to the use of this technique, the RPT can be safely performed and could represent a promising strategy to reduce the circulatory arrest time during aortic arch surgery. Nevertheless, further studies are required to demonstrate its efficacy.

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Section: Resultsmentioning

confidence: 99%

Evaluation of the “release and perfuse technique” for aortic arch surgery

Piperata

D’Ostrevy

Busuttil

et al. 2022

Journal of Cardiac Surgery

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“…The true lumen is rapidly perfused after making the distal anastomosis followed by the execution of the proximal aortic and cerebral arterial trunk anastomoses. [28] Gambardella and colleagues observed that spinal cord injury after elective and open thoracoabdominal aorta aneurysm repair for chronic type A dissection is a rare complication. [31] The indication for a frozen elephant trunk procedure is questionable considering the limited percentage of patients requiring a late distal reoperation [8,19,20] and therefore caution is warranted in recommending the use of routine frozen elephant trunk.…”

Section: Discussionmentioning

confidence: 99%

Surgical Strategy for Repair of Acute Type A Aortic Dissection: A Multicenter Study

Nappi¹,

Singh²,

Gambardella³

et al. 2023

Preprint

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Type A acute aortic dissection are associated with significant morbidity and mortality with prompt referral imaging and management to tertiary referral centres needed urgently. Surgery is usually needed emergently but the choice of surgery often varies depending on the patient and presentation. Staff and center expertise also play a major role in determining the surgical strategy employed The aim of this study is to compare early and medium term outcomes of patient across 3 European referral centers. We also identified risk factors for poorer outcomes irrespective of surgical strategy employed. A retrospective study was conducted across 3 sites between January 2008 and December 2021. 601 patients were included within the study of which 30% were female and the median age was 64.4 years. The most common operation was ascending aorta replacement (n= 246, 40.9%). The aortic repair was extended proximally (i.e., root n= 105; 17,5%) and distally (i.e., arch n = 250; 41,6%). A more extensive approach, extending from the root to the arch, was employed in 24 patients (4.0%). Operative mortality occurred in 146 patients (24.3%), and the most common morbidity was stroke (75, 12.6%). An increased length of ICU admission was noted in the extensive surgery group who were younger and more frequently male No significant differences were noted in surgical mortality from patients managed with extensive surgery vs those managed conservatively. However, age, arterial lactate levels, “intubated/sedated” status on arrival, and “emergency or salvage” status at presentation were independent predictors of mortality both within the index hospitalization and also during follow-up. Overall survival was similar between the groups.

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“…[32] Recently, there have been reports of anastomosis in zone 0. [33] The main goal is to repair the aorta in a single stage. However, the shorter the stent graft, the higher the rate of secondary aortic intervention (SAI).…”

Section: Discussionmentioning

confidence: 99%

Two-stage aortic surgery for distal aortic arch and descending aorta aneurysms: A case report

et al. 2022

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Rationale: Although surgical treatment strategies for patients with extensive thoracic aortic disease involving the aortic arch have improved considerably, the impact of stent graft length and placement site on aortic remodeling at long-term follow-up is not fully understood, and the protection of the Adamkiewicz artery (AKA) using the frozen elephant trunk (FET) method is also unclear.Patient concerns: The patient was a 69-year-old man with diabetic nephropathy who became increasingly fatigued and started maintenance hemodialysis 6 months prior to admission. At 64 years, he underwent clipping of a right cerebellar artery aneurysm. In addition, a 1.8 cm aneurysm was found in the contralateral extracranial internal carotid artery. He also had an atrial septal defect and moderate aortic regurgitation and was receiving continuous positive airway pressure therapy for sleep apnoea syndrome.Diagnosis: He had aneurysms in the aortic arch (4.8 cm in diameter) and descending aorta (6 cm in diameter), which was located at T6-9. Preoperative 3-dimensional computed tomography showed that the (AKA) bifurcated at T10-11.Interventions: Considering the patient's several comorbidities and frailty, we planned to perform 1-stage extended aortic arch repair using the FET procedure. However, we performed 2-stage aortic surgery to prevent spinal ischemia, anticipating substantial cardiac enlargement and blood pressure instability due to dialysis treatment. Aortic valve replacement, atrial septal defect patch closure, and aortic arch surgery were performed. A 7-cm elephant trunk was inserted in the descending aorta. Postoperatively, the patient continued rehabilitation until his blood pressure stabilized during dialysis therapy. At postoperative week 4, he underwent thoracic endovascular aortic repair for a descending aortic aneurysm.Outcomes: After surgery, his physical strength decreased; however, he recovered and was discharged 1 month later without any complications. One year after the second operation, he is living a healthy life.Lessons: Extensive aortic arch surgery using the FET procedure is effective for distal aortic arch and descending aortic aneurysms. Nevertheless, in cases in which the position of the AKA is close to the aortic aneurysm and blood pressure control is difficult, a 2-stage procedure and accurate positioning of thoracic endovascular aortic repair are both desirable.

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

Cited by 7 publications

References 13 publications

Evaluation of the “release and perfuse technique” for aortic arch surgery

Evaluation of the “release and perfuse technique” for aortic arch surgery

Surgical Strategy for Repair of Acute Type A Aortic Dissection: A Multicenter Study

Two-stage aortic surgery for distal aortic arch and descending aorta aneurysms: A case report

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