The Buffalo Trunk Technique for Aortic Arch Reconstruction

Eldeiry, Mohamed; Aftab, Muhammad; Bergeron, Edward J.; Pal, Jay D.; Cleveland, Joseph C.; Fullerton, David A.; Reece, T. Brett

doi:10.1016/j.athoracsur.2019.03.034

Cited by 15 publications

(10 citation statements)

References 27 publications

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“…Of 64 studies reporting outcomes of patients included in this report 13–76 . The proportions of studies from Asia, Europe, and North America were 54.7%, 31.3%, and 10.9%, respectively.…”

Section: Methodsmentioning

confidence: 99%

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

et al. 2021

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Background and Aim of the Study The frozen elephant trunk (FET) procedure became a popular entity for utilization in aortic arch aneurysm disease. However, its proper mortality and morbidities as well as the predictors of outcomes are poorly identified. This systematic review and meta‐analysis explore FET outcomes and its predictors with a focus on zone aortic proximalization. Methods We searched PubMed/MEDLINE, EMBASE, and Scopus databases from their beginning to June 2020 to find studies reporting the outcomes of the FET procedure for the total arch replacement (TAR). Results A total of 64 studies including 7967 patients were evaluated. The pooled estimates of cerebrovascular accidents, paraplegia, renal failure, and in‐hospital mortality were 7.104 (95% confidence interval [CI], 5.691–8.661; I2 = 78.53%), 3.465 (95% CI, 2.852–4.136; I2 = 15.96), 14.969 (95% CI, 11.361–18.977; I2 = 91.26%), and 8.933 (95% CI, 7.128–10.919; I2 = 78.51%), respectively. Stratification by the geographical locations and by the aortic pathologies led to lower heterogeneity, but not for renal failure. The distal anastomosis in Zone 2 was associated with a lower rate of renal failure compared with Zone 3 (odds ratio, 0.54; 95% CI, 0.36–0.81; p = .003; I2 = 0%). Conclusions The FET procedure for TAR can be performed with acceptable mortality and morbidities among patients with complex aortic pathologies. Moreover, the distal anastomosis in Zone 2 was associated with lower renal failure compared to Zone 3.

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“…Of 64 studies reporting outcomes of patients included in this report 13–76 . The proportions of studies from Asia, Europe, and North America were 54.7%, 31.3%, and 10.9%, respectively.…”

Section: Methodsmentioning

confidence: 99%

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

et al. 2021

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“…The "branch-first" technique of arch vessel management allows for dramatic reductions in circulatory arrest times, and while not strictly speaking necessary for cerebral protection, provides bilateral ACP during circulatory arrest. The Buffalo Trunk technique has also streamlined the construction of the distal anastomosis in TAR with FET resulting in further reductions in HCA time, which we have previously described (66). Shorter circulatory arrest times for TAR have made targeting warmer nadir temperatures safe, as we have been able to limit end organ ischemia.…”

Section: Arch Extent and Proximal Repairmentioning

confidence: 99%

Cerebral protection in type A aortic dissection

Ghincea¹,

Aftab²,

Ikeno³

et al. 2021

J Vis Surg

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Acute type A aortic dissection (ATAD) carries extremely high morbidity and mortality with a significantly increased risk of cerebrovascular injury following repair compared to elective arch operations.Advancement in operative and neuroprotective strategies have led to a temporal improvement in outcomes, but the incidence of cerebrovascular injury remains high and warrants continued innovation. In the setting of ATAD, stroke can occur due to malperfusion resulting from true lumen compression and compromised cerebral inflow, malperfusion from cardiogenic shock, or embolization. Therefore, stroke mitigation strategies must address vascular obstructions, hemodynamic compromise, and reduce risk of embolization. This article reviews contemporary strategies for cerebral protection in ATAD including preoperative patient evaluation, perfusion and temperature management, extent of aortic repair, utility of cerebral oximetry and neuromonitoring, and pharmacological adjuncts. In summary, patients should be evaluated preoperatively with contrast imaging to fully characterize their dissection to facilitate well-informed operative planning.Cannulation for cardiopulmonary bypass (CPB) can be safely achieved through multiple routes, but should consider patient pathology and the intended approach to cerebral perfusion. Central cannulation is feasible in most patients and allows for the most expeditious initiation of CPB. Although both deep hypothermic circulatory arrest (HCA) with retrograde cerebral perfusion (RCP) and moderate HCA with antegrade cerebral perfusion (ACP) have been shown to provide adequate cerebral protection, targeting moderate hypothermic temperatures reduces CPB times. The combination of a brief period of RCP followed by ACP during moderate HCA allows for the potential flushing of emboli from the cerebral arterial system with the superior metabolic protection of antegrade perfusion. The proximal and distal extent of arch repair should be individually tailored to patient pathology and surgeon experience, making sure to completely resect disease to prevent acute neurological complications. Cerebral oximetry and neuromonitoring are useful adjuncts, providing real-time information about the adequacy of neuroprotection. Finally, co-management by anesthesiologists and perfusionists with administration of neuroprotective agents, appropriate pH management, and maintenance of normal metabolic hemostasis and hemodynamic stability will further minimize cerebrovascular complications. Optimal cerebral protection requires a comprehensive, interdisciplinary approach and implementation of multimodal strategies.

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“…If a distal aortic intervention is required later, shifting the treatment level to the mid thoracic aorta with the use of either a classic or FET facilitates a technically easier re-operation that avoids hypothermic circulatory arrest and reduces risk of recurrent laryngeal nerve injury. If no pre-mated hybrid FET devices are available, the surgeons can use a commercially available TEVAR graft that is deployed into the descending aorta during circulatory arrest and can be then incorporated into the distal aortic anastomosis (43)(44)(45).…”

Section: Operative Considerationsmentioning

confidence: 99%

Total arch replacement in the treatment of acute type A aortic dissection

Attia¹,

Cameron²,

Sundt³

et al. 2021

J Vis Surg

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The role of total arch replacement (TAR) in patients with acute type A aortic dissection (ATAD) has been much debated. There are numerous factors that contribute to the clinical decision-making process.These include patient cohort, clinical status of the patient, aortic anatomy, dissection morphology, and expertise of the surgeon and the center. In this review, we summarize early and late outcomes of TAR in ATAD patients and discuss the specific patient populations that may benefit from an aggressive surgical approach at the time of the initial acute presentation. We discuss techniques for TAR, differences in aortic remodeling, and long-term aortic prognosis of these patients.

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The Buffalo Trunk Technique for Aortic Arch Reconstruction

Cited by 15 publications

References 27 publications

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

Cerebral protection in type A aortic dissection

Total arch replacement in the treatment of acute type A aortic dissection

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