Proximalized Total Arch Replacement Can Be Safely Performed by Trainee

Abstract

<jats:title>Abstract</jats:title><jats:p> Background The aim of the present study was to validate safety of total arch replacement (TAR) using a novel frozen elephant trunk device, operated by trainees as surgical education.</jats:p><jats:p> Methods Sixty-four patients including 19 patients (29.6%) with acute aortic dissection type A (AADA) underwent TAR in our institute between April 2014 and March 2019 were retrospectively analyzed. Twenty-nine patients were operated by trainees (group T) and 35 patients were operated by attending surgeons (group A).</jats:p><jats:p> Results Patient characteristics did not differ between groups. Operative time (409.4 ± 87.8 vs. 468.6 ± 129.6 minutes, p = 0.034), cardiopulmonary bypass time (177.7 ± 50.4 vs. 222.9 ± 596.7 minutes, p = 0.019), and hypothermic circulatory arrest time (39.5 ± 13.4 vs. 54.5 ± 18.5 minutes, p = 0.001) were significantly shorter in group A than in group T, but aortic clamping time did not differ between groups (115.3 ± 55.7 vs. 114.2 ± 35.0 minutes, p = 0.924) because the rate of concomitant surgery was higher in group A (37.1 vs. 10.3%, p = 0.014). Thirty-day mortality was 3.1% in the entire cohort. Although operation time was longer in group T, there were no significant difference in postoperative results between the groups, and the experience levels of the main operator were not independent predictors for in-hospital mortality + major postoperative complications. There was no difference in late death and aortic events between groups.</jats:p><jats:p> Conclusions The present study demonstrated that TAR can be safely performed by trainees, and suggests TAR as a possible and safe educational operation.</jats:p>

Silent cerebral ischemia detected by magnetic resonance imaging can predict postoperative delirium after total arch replacement for aneurysm

“…Operator factors can influence the surgical time, as we have previously reported. 29 Surgical education is important, but considering the results of the present study, an experienced operator should perform AR in high-risk patients.…”

Proximal and extended aortic arch replacement in acute DeBakey type I aortic dissection

“…In cases of a FET, the subclavian artery was reconstructed extra-anatomically using an 8 mm expanded polytetrafluoroethylene prosthesis (Gore Propaten; W Gore & Associates, Flagstaff, Ariz, United States) anastomosed to the left axillary artery through a separate incision. With this extra-anatomical procedure, all anastomoses can be performed in relatively safe position by avoiding deep distal anastomosis and avoiding in-situ reconstruction of the left subclavian artery, therefore we preferred it ( 10 ). If a FET was not used, the distal anastomosis was performed using the classical elephant trunk technique.…”

Early Results of a Novel Hybrid Prosthesis for Treatment of Acute Aortic Dissection Type A With Distal Anastomosis Line Beyond Aortic Arch Zone Zero

“…To simplify the therapy of AADA and make the operation performable for most surgeons irrespective of their specific experience profile, HAR has become a commonly applied technique. Furthermore, according to previous reports, TAR can be performed by nearly all surgeons due to the simplification of the implantation technique, however, an increased risk of stroke remains ( 10 , 11 ). The Ascyrus Medical Dissection Stent (AMDS Hybrid Prosthesis, Cryolife/Jotec, Hechingen, Germany) has been designed to simplify surgical treatment of the downstream thoracic aorta by implantation line located proximal to the brachiocephalic trunk (zone 0), in addition to the standard replacement of the ascending aorta.…”