Optimization of the total arch replacement technique: Left subclavian perfusion with sequential aortic reconstruction

Ma, Wei-Guo; Sun, Li‐Zhong

doi:10.1016/j.jtcvs.2020.11.110

Cited by 9 publications

(7 citation statements)

References 4 publications

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“…The c-TAR refers to Sun’s procedure, which has been reported previously ( 6 ). Briefly, the three supra-aortic branches were extensively dissociated and the distal aorta was transected just proximal to the origin of the LSA.…”

Section: Methodsmentioning

confidence: 99%

“…The aortic arch and its three supra-aortic vessels remain a great surgical challenge for reconstruction ( 5 ). In China, Sun’s procedure is the conventional choice for total arch replacement (c-TAR), which has produced satisfactory early and long-term results since its introduction in 2003 ( 6 ). However, separate reimplantation of the three supra-aortic branches is a complex, traumatic technique, and the long cardiopulmonary bypass (CPB) and circulatory arrest times may also increase the risk of postoperative complications ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Zheng¹,

Yu²,

Lin³

et al. 2023

J Thorac Dis

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Background: Reconstruction of the aortic arch and its three supra-aortic vessels remains a great surgical challenge with postoperative complications. We present a simplified total arch reconstruction with a modified stent graft (s-TAR) and compared its operative outcomes with conventional total arch replacement (c-TAR).Methods: This retrospective analysis of prospectively collected data from all consecutive patients who had ascending aortic aneurysm with extended aortic arch dilation and underwent simultaneous ascending aorta replacement and aortic arch reconstruction with the s-TAR or c-TAR between 2018 and 2021. The indication for intervention was maximum diameter of ascending aorta >55 mm and aortic arch in zone II >35 mm.Results: A total of 84 patients were analyzed: 43 in the s-TAR group and 41 in the c-TAR group. No inter-group differences were found for sex, age, comorbidities, or EuroSCORE II results. All patients were successfully treated with s-TAR or c-TAR, and none died intraoperatively. Cardiopulmonary bypass, selective cerebral perfusion, and lower-body circulatory arrest time were significantly shorter in the s-TAR group, which also had a lower incidence of prolonged ventilation and transient neurologic dysfunction. No patient in either group experienced permanent neurologic dysfunction. The incidence of recurrent laryngeal nerve injury and paraplegia was markedly increased in the c-TAR group; however, no such events were observed in the s-TAR group. Both perioperative blood loss and the incidence of reoperation for bleeding were significantly lower in the s-TAR group. The in-hospital mortality rate was 0% in the s-TAR group and 4.9% in the c-TAR group. The s-TAR group had significantly shorter ICU stay and lower total hospitalization costs. Conclusions:The s-TAR technique is a safe and effective alternative for total arch reconstruction with shorter operation time, lower rate of postoperative complications and lower total hospitalization costs compared with c-TAR.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Zheng¹,

Yu²,

Lin³

et al. 2023

J Thorac Dis

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“…Previous reports have proposed modifications to the FET technique that reduce or avoid hypothermic circulatory arrest using aortic balloon occlusion (to block blood flow from the femoral perfusion) or the femoral and right axillary arteries for systemic cooling with no distal anastomosis 9,10 . However, clamping the distal arch can produce other problems as can ballooning in dissections 11 .…”

Section: Commentmentioning

confidence: 99%

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

Sénage

Bonnet

Guimbretière

et al. 2021

Journal of Cardiac Surgery

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A simplified delivery technique for the frozen elephant trunk procedure allows the distal suture to be performed on a perfused and loaded aorta in moderate hypothermia—or even normothermia—reducing circulatory arrest time to just a few minutes. Two surgical sealing tourniquets are placed around the aortic arch, usually between the brachiocephalic trunk (BCT) and the left common carotid artery and the aorta is cross‐clamped and cardioplegia started. Once in mild hypothermia, the BCT is disconnected and circulatory arrest is initiated while cerebral perfusion is maintained. This modified technique can be used in all pathologies, including dissections.

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“…The left subclavian artery is cannulated to address a possible incomplete circle of Willis and to optimize blood flow into the left hemisphere. 2 For the FET technique, the authors use a 6.5-cm proximal unstented Dacron graft (MicroPort Medical, Shanghai, China) deployed into the descending thoracic aorta with no distal anastomosis. After graft deployment, the distal arch with the proximal unstented FET graft is clamped, and circulatory arrest is terminated.…”

mentioning

confidence: 99%

“…The reported circulatory arrest time is approximately 2.6 minutes, and cerebral perfusion time is approximately 8 to 9 minutes. 2 This strategy is interesting, but to be successful it requires favorable body habitus and favorable anatomy of the aortic arch and proximal descending thoracic aorta. In our experience, clamping the distal arch in these patients is usually difficult, and additional dissection of already fragile tissues is required.…”

mentioning

confidence: 99%

Commentary: No distal anastomosis and negligible circulatory arrest time during frozen elephant trunk technique: More evidence is needed

Preventza

Cruz

2021

The Journal of Thoracic and Cardiovascular Surgery

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Optimization of the total arch replacement technique: Left subclavian perfusion with sequential aortic reconstruction

Cited by 9 publications

References 4 publications

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

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

Commentary: No distal anastomosis and negligible circulatory arrest time during frozen elephant trunk technique: More evidence is needed

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