The goal of simplifying complex aortic arch surgery

Detter, Christian; Brickwedel, J.

doi:10.1093/ejcts/ezab075

Cited by 5 publications

(10 citation statements)

References 6 publications

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“…Moreover, there is an undisputed need to simplify the complex aortic procedures and endovascular techniques are playing a key role in evolving in this direction. 19 We believe that our technique could give an important contribution and impetus in pursuing this goal, having the advantage to reduce the circulatory arrest time.…”

Section: Resultsmentioning

confidence: 98%

“…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%

“…Di Eusanio and colleagues 18 have recently published a hybrid technique involving the use of balloon endoclamping and femoral cannulation. 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 …”

Section: Discussionmentioning

confidence: 99%

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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: 98%

Section: Resultsmentioning

confidence: 99%

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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 technique that we proposed represents another "fish in the sea", but despite the limitations related to the seal of the landing zone, the RPT appears to be safe and effective in reducing the circulatory arrest time. Moreover, there is an undisputed need to simplify the complex aortic procedures and endovascular techniques are playing a key role in evolving in this direction (22). In this context, we strongly believe that our technique could represent an important contribution and impetus in pursuing this goal, having the advantage to simplify the classic FET procedure.…”

Section: Concusionmentioning

confidence: 96%

“…Di Eusanio and colleagues (20) had recently published a hybrid technique to perform complex aortic arch surgery avoiding circulatory arrest time and remaining normothermic. This technique involving the use of balloon endoclamping and femoral cannulation seems to be promising, and it represents the last effort of surgical community to resolve the problem of circulatory arrest time during aortic arch surgery (20)(21)(22).…”

Section: Concusionmentioning

confidence: 99%

Preliminary results of single centre experience with the “release and perfuse technique” during aortic arch surgery.

Piperata

D’Ostrevy

Busuttil

et al. 2022

Preprint

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Background and aim of the study To evaluate whether the release and perfuse technique implies a circulatory arrest time comparable with or shorter than those of standard Frozen Elephant Trunk technique in aortic arch surgery. Methods We retrospectively reviewed the records of patients who had undergone aortic arch repair with Release and Perfuse Technique (RPT) or standard Frozen Elephant Trunk (FET) at our Institution between January 2018 and May 2021. Primary endpoints were the comparison of circulatory arrest time, perioperative variables, and complications between two groups. A propensity score weighting approach was used for data analysis. Results A total of 41 patients underwent aortic arch surgery were analyzed:15 (37%) and 26 (63 %) in RPT and FET group, respectively. The use of RPT showed a significant shorter circulatory arrest times than FET: 9 min vs 58 min (P < 0.001), respectively. The median lactates peak in the first 24h post intervention was 2.6 for RPT group and 5.4 mmol/L for FET group, (P <0.0001). When compared with the FET, RPT is associated with significant reduction in the use of packed red blood cells (P <0.0001), fresh frozen plasma (P <0.0001), platelet concentrate (P <0.0001), and fibrinogen (P <0.004). The median ICU stay was 3 and 9 days (P = 0.011), whereas the median hospital stay was 12 and 18.5 days (P=0.004) in the RPT and FET groups, respectively. Thirty-day mortality and postoperative outcomes were comparable between the two groups. Conclusions Considering the anatomical limitations related to the use of this technique, the RPT appears to be safe, feasible, and effective in reducing the circulatory arrest time during aortic arch surgery. Nevertheless, further studies are required to demonstrate its safety and efficacy.

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Zerebrale Protektion und Kanülierungstechniken im Rahmen der Aortenbogenchirurgie

Detter

Brickwedel

2023

Z Herz- Thorax- Gefäßchir

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The goal of simplifying complex aortic arch surgery

Cited by 5 publications

References 6 publications

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

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

Preliminary results of single centre experience with the “release and perfuse technique” during aortic arch surgery.

Zerebrale Protektion und Kanülierungstechniken im Rahmen der Aortenbogenchirurgie

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