Modification in aortic arch replacement surgery

Gao, Feng; Ye, Yongjie; Zhang, Yongheng; Yang, Bo

doi:10.1186/s13019-017-0689-y

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…The “branch-first” technique has been described previously in a few reports [5]. The advantage of the “branch-first” technique is ensuring antegrade perfusion of the brain, thus avoiding poor perfusion of the axillary artery in patients with an incomplete cerebral arterial circle (Circle of Willis) while reducing the cardiac arrest time.…”

Section: Discussionmentioning

confidence: 99%

Total aortic arch replacement surgery with a Core temperature of 34 °C

Li¹,

Qu²,

Liu³

et al. 2019

J Cardiothorac Surg

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BackgroundTraditional aortic arch replacement surgery must be performed under moderate or deep hypothermia (22–28 °C) and circulatory arrest. Hypothermia and hypoperfusion can cause damage to the nervous system; therefore, postoperative brain and spinal cord complications are common. Improvements in surgical techniques are necessary to solve this problem. Herein, we report a method of total aortic arch replacement that can be performed at a core temperature of 34 °C, similar to other simple cardiac operations.Case presentationFour patients underwent surgery with this technique (3 males and 1 female, aged 48 to 67 years). Computed tomography angiography performed at admission showed a total aortic dissection, resulting in a diagnosis of Stanford type A aortic dissection. The patients underwent emergency aortic sinus remodelling, ascending aortic replacement, modified aortic arch replacement, and elephant trunk stenting. No patients had neurological complications. During a follow-up of more than 1-month, no patients had aortic valve regurgitation or anastomotic leak.ConclusionsThis technique can increase the operating temperature by approximately 6 to 12 °C and reduce the circulatory arrest time by approximately 18 to 28 min. All of the patients recovered well without any neurological complications, demonstrating the feasibility and safety of this technique. We believe that this technique can serve as a good alternative strategy for managing aortic dissection and aneurysm, especially for young surgeons who are acquiring experience in arch replacement surgery.

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Section: Discussionmentioning

confidence: 99%

Total aortic arch replacement surgery with a Core temperature of 34 °C

Li¹,

Qu²,

Liu³

et al. 2019

J Cardiothorac Surg

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Can a ‘branch-first’ approach to aortic arch replacement be safely utilized in Stanford type A acute aortic syndromes?

Kemp,

Zhu

2023

Interdisciplinary CardioVascular and Thoracic Surgery

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Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: “Can a “branch-first” approach to aortic arch replacement be safely utilised in Stanford Type A acute aortic syndromes?” Altogether 64 papers were found using the reported searches, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All papers included in this BET reported acceptable mortality and/or neurological outcomes in comparison to currently published standards for traditional repair. We conclude that while there is a need for larger series, direct comparison and long term follow-up, the “branch-first” approach to aortic arch replacement has been safely performed in several centres in the setting of acute aortic syndromes with results demonstrating acceptable mortality, neurological outcomes, and mid-term survival.

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Branch‐First Technique of Aortic Arch Replacement: A Systematic Review and Meta‐Analysis

Bakr,

Wijesena,

De Silva

et al. 2024

Journal of Cardiac Surgery

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Objectives. Aortic arch replacement is a major surgical intervention. This meta‐analysis aims to combine the international literature on the branch‐first technique to describe its outcomes and offer a comparison to the standard techniques. Methods. PubMed and Cochrane were searched for studies on the branch‐first technique in aortic arch surgery including those comparing this technique with the conventional ones. Mortality, neurological complications, bleeding, and renal replacement therapy were the major endpoints of interest. Subgroup analysis was performed for both single‐ and double‐armed studies. Odds ratios with 95% confidence interval were used as summary estimates. The random‐effects model was used for all outcomes. Results. Ten studies from three countries with a total of 498 patients were included. Proportional analysis of the branch‐first technique estimated mortality of (3%, 95% CI [0.02–0.05]), neurological complications of (8%, 95% CI [0.03–0.13]), re‐exploration for bleeding of (9%, 95% CI [0.05–0.13]), and renal replacement therapy of (9%, 95% CI [0.05–0.12]). This meta‐analysis revealed no significant differences between the branch‐first technique and the conventional technique in mortality (5% vs. 15%, OR = 0.32, 95% CI [0.08–1.18], p = 0.09, I2 = 40%), neurological complications (10% vs. 16%, OR = 0.53, 95% CI [0.24–1.21], p = 0.13, I2 = 0%), or renal replacement therapy (12% vs. 14%, OR = 0.72, 95% CI [0.33–1.59], p = 0.41, I2 = 0%). Conclusions. Branch‐first technique provides a promising alternative approach in aortic arch surgery with no different surgical risks and potentially reduced operative complexity. Randomised controlled trials are needed to further investigate the safety and advantages of this technique.

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Modification in aortic arch replacement surgery

Cited by 3 publications

References 4 publications

Total aortic arch replacement surgery with a Core temperature of 34 °C

Total aortic arch replacement surgery with a Core temperature of 34 °C

Can a ‘branch-first’ approach to aortic arch replacement be safely utilized in Stanford type A acute aortic syndromes?

Branch‐First Technique of Aortic Arch Replacement: A Systematic Review and Meta‐Analysis

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