One minute of circulatory arrest for acute type A aortic dissection --------- a simple operation for acute type A aortic dissection (AAAD)

Abstract

Background Sun’s procedure is currently recognized as the standard procedure for acute type A aortic dissection (AAAD). But the operation istoo difficult for beginners. We hope to reduce the difficulty and complications of this operation. Methods The aortic arch was immediately cross-clamped after the stented graft was inserted into the distal aorta. Thereafter, the lower-body perfusion was restored. Then, anastomosis was performed between the proximal stent graft and the distal 4-branched Dacron graft. The other arteries were anastomosed to the arched branch of the 4-branched graft. Results The cardiopulmonary bypass (CPB) time was (207 ± 52) min, and the aortic cross-clamp time was (114 ± 39) min. The circulatory arrest time was (38 ± 16) sec. One patient (4%) died. The incidence of complications was stroke (4%), renal dysfunction requiring dialysis (4%), prolonged intubation(12%). Conclusions The time of circulatory arrest in this operation is less than 1 min, which can avoid the complications caused by DHCA and decrease risk of bleeding and complexity by shifting anastomosis more proximally. The effect of our operation is similar to and even better than that of Sun’s procedure. It does not even require relatively advanced skill, much experience and excellent psychological quality, especially suitable for beginners.

Editor's Choice – Extending Aortic Replacement Beyond the Proximal Arch in Acute Type A Aortic Dissection: A Meta-Analysis of Short Term Outcomes and Long Term Actuarial Survival

“…These four branched prostheses facilitate early re-initiation of systemic perfusion through one of the branches, after completion of the distal anastomosis. 42 Some authors have even suggested nearly eliminating CA, as they either clamp the stent graft distally after insertion, 43 or occlude the distal stent using a balloon, 44 leading to significantly fewer renal complications. 45 Moreover, another meta-analysis has suggested axillary artery cannulation to be superior to femoral cannulation, in terms of mortality and neurological complications.…”

Risk factors for postoperative acute kidney injury in overweight patients with acute type A aortic dissection

“…Intraoperative cryogenic extracorporeal circulation, the longer will likely affect kidney blood supply, increase renal ischemia hypoxia, cause kidney damage, plus the extracorporeal circulation leads to the activation of systemic inflammation factors, a systemic inflammatory response syndrome, thus appeared the body each viscera, the damage to the organization, and ischemia, corresponding viscera function is not complete. Secondly, the turnaround time of CPB is under the condition of deep and low temperature, and the coagulation balance of the whole body is broken, which further aggravates the burden of kidney and causes AKI [ 24 ]. In this study, suspended red blood cell infusion was an independent risk factor for postoperative AKI in overweight ATAAD patients ( P = 0.015).…”

Simplified Arch-first Technique in Aortic Arch Branches Replacement: Perfusion without Cardiopulmonary Bypass

“…The conventional Sun's surgical method uses unilateral cerebral perfusion by CPB to maintain the perfusion of the brain, and the reconstruction of arch branches must be performed under CPB 4 . Although the other arch-first technique before us ensured the cerebral perfusion or reduced time, they were still performed under CPB [8][9][10][11] .…”