Brain Protection in Aortic Arch Surgery: An Evolving Field

Qu, Jason; Kao, Lee-Wei; Smith, Jennifer E.; Kuo, Alexander S.; Xue, Albert; Iyer, Manoj H.; Essandoh, Michael; Dalia, Adam A.

doi:10.1053/j.jvca.2020.11.035

Cited by 37 publications

(33 citation statements)

References 110 publications

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“…Correct cerebral perfusion during hypothermic circulatory arrest is one of the main factors determining neurological outcomes. [7][8][9] Our strategy allows a uniform cerebral perfusion throughout the operation, except for the short time needed for LCA and LSA anastomosis, thus minimizing cerebral ischemia time. We believe that this technical aspect is important to explain our particularly good results in terms of neurological complications, with a significantly lower overall incidence of permanent stroke (1.4%) compared to data from similar studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of the Frozen Elephant Trunk procedure in 70 emergent and elective patients undergoing aortic arch surgery: the Salerno experience with Thoraflex Hybrid

Masiello

Mastrogiovanni

Presutto

et al. 2021

Preprint

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Background and aim of the study. To report early clinical outcomes of the frozen elephant trunk technique (FET) for the treatment of complex aortic diseases after transition from conventional elephant trunk. Methods. A single-center, retrospective study of patients who underwent hybrid aortic arch and FET repair for aortic arch and/or proximal descending aortic aneurysms, acute and chronic Stanford type A aortic dissection with arch and/or proximal descending involvement, Stanford type B acute and chronic aortic dissections with retrograde aortic arch involvement. Results. Between December 2017 and May 2020, 70 consecutive patients (62.7±10.6 years, 59 male) were treated: 41 (58.6%) for acute conditions and 29 (41.4%) for chronic. Technical success was 100%. In-hospital mortality was 14.2% (n=12, 17.1% emergency vs. 10.3% chronic, P=NS); 2 (2.9%) major strokes; 1 (1.4%) spinal cord injury. Follow-up was 12.5 months (IQR 3.7—22.3. Overall survival at 3, 6, 12 and 24 months was 90% (95% CI, 83.2—97.3), 85.6% (95% CI, 77.7—94.3), 79.1% (95% CI, 69.9—89.5), 75.6% (95% CI, 65.8—86.9) and 73.5 (95% CI, 63.3—85.3). There were no aortic re-interventions and no dSINE; 5 patients with residual type B dissection underwent TEVAR completion. Conclusions. In a real-world setting, FET demonstrated a rapid learning curve and good clinical outcomes, even in acute type A aortic dissections. Techniques to perfect the procedure and to reduce remaining risks, and consensus on considerations such as standardized cerebral protection need to be reported.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of the Frozen Elephant Trunk procedure in 70 emergent and elective patients undergoing aortic arch surgery: the Salerno experience with Thoraflex Hybrid

Masiello

Mastrogiovanni

Presutto

et al. 2021

Preprint

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“…Organ protection involves advanced strategies which allow increasing tolerance to ischemia of the brain, spinal cord, myocardium, and visceral organs. There is a large body of evidence supporting the principle that selective antegrade cerebral perfusion (SACP) according to the Kazui's technique for brain protection is a valid option to achieve an effective cerebral protection during the phase of circulatory arrest [19,20]. This strategy, relying on the integrity of the circle of Willis, is commonly adopted together with moderate hypothermia, lowering patient's nasopharyngeal temperature to 26-28 • C. However, it is well known that anatomic variations may occur, leaving a considerable number of patients still at risk for neurologic injuries despite the SACP strategy [21].…”

Section: Cerebral Spinal Cord Viscera and Heart Protectionmentioning

confidence: 99%

Frozen Elephant Trunk Technique in Acute Type A Aortic Dissection: Is It for All?

et al. 2021

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Acute type A aortic dissection (ATAAD) is an indisputable emergency with very poor outcomes without surgical treatment. Although the aortic arch is often involved in the aortic dissection, its optimal management during surgical therapy remains uncertain. A conservative tear-oriented approach has traditionally been adopted, limiting the procedure to the ascending aorta (or hemiarch) replacement. However, dilation of the residual dissected aorta and subsequent rupture may occur, requiring further intervention in the future. In the last two decades, the frozen elephant trunk (FET) technique has become a valid and attractive option to treat aortic disease when the arch and the thoracic aorta are involved, both in elective and in emergency settings. Here, we report a review of the contemporary literature regarding the short- and long-term outcomes of the FET technique in ATAAD repair.

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“…Відповідно до сучасних тенденцій (останні кілька років змінена нами на етапну) тактика лікування такого грізного ускладнення ефективно покращила виживаність таких хворих [4,5,14]. Це дало змогу відновити блокований розшаруванням кровоплин і підтримати його в достатній мірі як під час операції, так і в післяопераційному періоді.…”

Section: український журнал серцево-судинної хірургії 2021 1 (42)unclassified

Methods and Results of the Brain and Visceral Organs Protection During the Correction of the Ascending Aorta and Aortic Arch Aneurysm or Isolated Aortic Arch Aneurism

Кравченко

Kravchenko

Zhekov

et al. 2021

ujcvs

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The ascending aorta and aortic arch aneurysm surgical correction is the most difficult problem of cardiovascular surgery due to the necessity of management of the main disease and adequate protection of the brain and visceral organs. The aim. To present the methods and results of protection of the central nervous system and visceral organs during the correction of the ascending aorta and aortic arch aneurysm or isolated aortic arch aneurism. Materials and methods. During 1994–2018, we operated 419 patients with the ascending aorta and aortic arch aneurysm (or isolated aortic arch aneurism). Diagnosis of aneurysms was based on clinical data, transthoracic and transesophageal echocardiography, computed tomography, X-ray examination, aortography. All operations were performed under general anesthesia, through the median sternotomy using cardiopulmonary bypass. Valve-sparing technique with aortic valve resuspension/aortic valve plasty and semi-arch/arch replacement was used in 288/9 (68.7%) patients. Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%) patients. Other operations accounted for 45 (10.7%) patients. Results. The history of the development of aortic aneurysms treatment options is briefly overviewed in the paper. Diagnostic methods are mentioned, but the main method today is computed tomography. Initial status of the patients was severe. All operations were performed through median sternotomy using cardiopulmonary bypass. The following techniques were used for surgical treatment of aneurysms: 1) valve-sparing technique with aortic valve resuspension/ plasty and semi-arc/arch replacement was used in 288/9 (68.7%) patients. In this group there were 8 Yacoub operations, 6 David operations. In 7 patients, plication of one of the leaflets was performed in case of aortic valve prolapse. 3 patients underwent strengthening of the free edge of the leaflets and 4 patients underwent plasty by the patch in case of leaflet fenestrations; 2) Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%); 3) others: isolated arch in 15 (3.6%); Wheat operation + arch in 9 (1.0%); aortic arch plasty in 4 (1.0%); Elephant trunk (conventional Elephant trunk) + TEVAR was used in 17 (4.1%) patients. The brain protection was performed differently at each of the two stages in our surgical experience. The best result was achieved at the last stage. The number of postoperative complications decreased from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%, respectively. Also, a modern endovascular method – hybrid operations Elephant trunk + TEVAR – was used in 17 (4.1%) patients with good immediate result. Conclusions. 1. At type A aortic dissection (DeBakey type I) the operation of choice is supracoronary ascending aortic replacement with a semi-arch (arch) replacement of the aorta. 2. Accumulation of surgical experience, team training, improvement of methods of protection of the brain and visceral organs allowed to reduce the number of postoperative complications from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%.

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Brain Protection in Aortic Arch Surgery: An Evolving Field

Cited by 37 publications

References 110 publications

Clinical outcomes of the Frozen Elephant Trunk procedure in 70 emergent and elective patients undergoing aortic arch surgery: the Salerno experience with Thoraflex Hybrid

Clinical outcomes of the Frozen Elephant Trunk procedure in 70 emergent and elective patients undergoing aortic arch surgery: the Salerno experience with Thoraflex Hybrid

Frozen Elephant Trunk Technique in Acute Type A Aortic Dissection: Is It for All?

Methods and Results of the Brain and Visceral Organs Protection During the Correction of the Ascending Aorta and Aortic Arch Aneurysm or Isolated Aortic Arch Aneurism

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