Aortic Arch Reconstructive Surgery With Conventional Techniques vs Frozen Elephant Trunk: A Systematic Review and Meta-Analysis

Hanif, H.; Dubois, Luc; Ouzounian, Maral; Peterson, Mark D.; El-Hamamsy, Ismaı̈l; Dagenais, François; Hassan, Ansar; Chu, Michael

doi:10.1016/j.cjca.2017.12.020

Cited by 87 publications

(82 citation statements)

References 44 publications

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“…In a recent survey, reporting the currents trends in cannulation and neuroprotection during aortic arch surgery in Europe, bilateral, and unilateral ACPs were the most commonly utilized methods, accounting for 53% and 38% of strategies in the acute setting, and for 65% and 33% in chronic aortic conditions, respectively 8 . Although these operative strategies are directed at reducing operative mortality and morbidity, the occurrence of temporary and permanent neurologic deficits remains high 1–4 . Even in elective proximal arch surgeries, a 6% rate of paraplegia is encountered, highlighting the need for further measures to reduce this devastating complication, especially in the case of more time demanding extensive aortic repairs 21 .…”

Section: Resultsmentioning

confidence: 99%

“…FET allows for single‐stage therapy in case of multilevel aortic diseases, favors the expansion of true lumen in type A acute dissections, and also offers a potential landing zone for subsequent transfemoral endovascular aortic repairs 1,3 . However, in this context, the optimal cerebral protection strategy remains controversial, and FET procedure‐related complications are not remote 1–4 . Neurological and spinal cord complications occur in 2.5% to 21% of treated patients 2,4 …”

Section: Introductionmentioning

confidence: 99%

“…However, in this context, the optimal cerebral protection strategy remains controversial, and FET procedure‐related complications are not remote 1–4 . Neurological and spinal cord complications occur in 2.5% to 21% of treated patients 2,4 …”

Section: Introductionmentioning

confidence: 99%

“…1,3 However, in this context, the optimal cerebral protection strategy remains controversial, and FET procedurerelated complications are not remote. [1][2][3][4] Neurological and spinal cord complications occur in 2.5% to 21% of treated patients. 2,4 To mitigate the risk of perioperative neurological complications during FET procedures, we have developed a modified cerebral perfusion strategy to both preserve the anterior and posterior…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Neurological and spinal cord complications occur in 2.5% to 21% of treated patients. 2,4 To mitigate the risk of perioperative neurological complications during FET procedures, we have developed a modified cerebral perfusion strategy to both preserve the anterior and posterior…”

Section: Introductionmentioning

confidence: 99%

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Computational fluid dynamics of a novel perfusion strategy during hybrid thoracic aortic repair

et al. 2020

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Background and Aim To mitigate the risk of perioperative neurological complications during frozen elephant trunk procedures, we aimed to computationally evaluate the effects of direct cerebral perfusion strategy through a left carotid‐subclavian bypass on hemodynamics in a patient‐specific thoracic aorta model. Methods Between July 2016 and March 2019, 11 consecutive patients underwent frozen elephant trunk operation using the left carotid‐subclavian bypass with a side graft anastomosis and right‐axillary cannulation for systemic and brain perfusion. A multiscale model realized coupling three‐dimensional computational fluid dynamics was developed and validated with in vivo data. Model comparison with direct antegrade cannulation of all epiaortic vessels was performed. Wall shear stress, wall shear stress spatial gradient, and localized normalized helicity were selected as hemodynamic indicators. Four cerebral perfusion flows were tested (6 to 15 mL/kg/min). Results Direct cerebral perfusion of the left subclavian bypass resulted in higher flow rates with augmented speeds in all epiaortic vessels in comparison with traditional perfusion model. At the level of the left vertebral artery (LVA), a speed of 22.5 vs 21 mL/min and mean velocity of 3.07 vs 2.93 cm/s were registered, respectively. With a cerebral perfusion flow of 15 mL/kg, lower LVA wall shear stress (1.596 vs 2.030 N/m2), and wall shear stress gradient (1445 vs 5882 N/m3) were observed. A less disturbed flow considering the localized normalized helicity was documented. No patients experienced neurological/spinal cord damages. Conclusions Direct perfusion of a left carotid bypass proved to be cerebroprotective, resulting in a more physiological and stable anterior and posterior cerebral perfusion.

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Section: Resultsmentioning

confidence: 99%