Mild Systemic Hypothermic Circulatory Arrest Using a Frozen Elephant Trunk Graft with Endo-Balloon Occlusion for Total Arch Replacement

Authors

  • Yoshihiro Goto, MD Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
  • Soh Hosoba, MD, PhD Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
  • Yuichiro Fukumoto, MD Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
  • Sho Takagi, MD, PhD Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
  • Junji Yanagisawa, MD Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan

DOI:

https://doi.org/10.1532/hsf.3135

Keywords:

total arch replacement, Frozen elephant trunk, thoracic aortic aneurysm, retrograde perfusion

Abstract

Background: Stroke and paraplegia are serious complications of total aortic arch replacement (TAR). Hypothermic circulatory arrest and cerebral perfusion reduce the risk of neurologic complications, but longer circulatory arrest time remains a risk factor for such complications. We utilized a frozen elephant trunk (FET) with endo-balloon occlusion under mild systemic hypothermia, which allowed us to shorten circulatory arrest time.

Methods: Between April 2007 and May 2020, 72 patients underwent elective TAR using antegrade cerebral perfusion (ACP). They were divided into 2 groups. 64 patients received conventional TAR with moderate systemic hypothermic (bladder temperature, 25–28°C) circulatory arrest (group C). We used a FET with endo-balloon occlusion and retrograde perfusion through the femoral artery for the newest 8 patients who had mild hypothermic (bladder temperature of 30°C) circulatory arrest (group B).

Results: The mean operation time (257.5 ± 42.1 versus 327.8 ± 84.9 min, P = .023), CPB time (144.4 ± 28.1 versus 178.2 ± 26.4 min, P = .003), cardiac arrest time (75.5 ± 21.2 versus 95.7 ± 56.4 min, P < .001), SCP time (100.8 ± 25.5 versus 124 ± 23.2 min, P < .001), lower body circulation arrest time (17.2 ± 4.2 versus 62.5 ± 19.3 min, P < .001) were significantly shorter in the endo-balloon occlusion group. There were no perioperative neurological and renal complications or mortality in FET group. The new technique enabled a decrease in mechanical ventilation time (8.6 ± 1.4 versus 13.9 ± 5.7 min, P = .015) and hospital length of stay (9.7 ± 1.8 versus 18.3 ± 4.6 min, P = .005).

Conclusion: FET using an endo-balloon occlusion with mild hypothermia is a safe and an effective approach in TAR.

References

Kato M, Ohnishi K, Kaneko M, et al. 1996. New graft implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation 94: II188-93.

Kazui T, Washiyama N, Muhammad BA, et al. 2000. Total arch replacement using arch branched grafts with the aid of antegrade selective cerebral perfusion. Ann Thorac Surg 70:3-8.

Kollef MH, Wragge T, Pasque C. 1995. Determinants of mortality and multiorgan dysfunction in cardiac surgery patients requiring prolonged mechanical ventilation. Chest 107:1395-1401.

Lei Q, Chen L, Zhang Y, et al. 2009. Predictors of prolong mechanical ventilation after aortic arch surgery with deep hypothermic circulatory arrest plus antegrade selective cerebral perfusion. J Cardiothorac Vasc Anesth 23:495-500.

Nota T, Asai T, Suzuki T, et al. 2014. Risk factors for acute kidney injury in aortic arch surgery with selective cerebral perfusion and mild hypothermic lower body circulatory arrest. Interact Cardiovasc Thorac Surg 19:955-61.

Okita Y, Miyata H, Motomura N, et al. 2015. A study of brain protection during total arch replacement comparing Antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the Japan Adult cardiovascular surgery database. J Thorac Cardiovasc Surg 149:S65-73.

Preventza O, Coselli JS, Garcia A, et al. 2017. Moderate hypothermia at warmer temperatures is safe in elective proximal and total arch surgery: Results in 665 patients. J Thorac Cardiovasc Surg 153:1011-18.

Suzuki T, Asai T, Nota H, et al. 2013. Selective cerebral perfusion with mild hypothermic lower body circulatory arrest is safe for aortic arch surgery. Eur J Cardiothorac Surg 43:e94-98.

Uchino S, Bellomo R, Goldsmith D, et al. 2006. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 34:1913-17.

Yau TM, Carson S, Weisel RD, et al. 1992. The effect of warm heart surgery on postoperative bleeding. J Thorac Cardiovasc Surg 103:1155-63.

Zierer A, Detho F, Dzemali O, et al. 2011. Antegrade Cerebral perfusion with mild hypothermia for aortic arch replacement: single center experience in 245 consecutive patients. Ann Thorac Surg 91:1868-74.

Published

2020-09-23

How to Cite

Goto, Y., Hosoba, S., Fukumoto, Y., Takagi, S., & Yanagisawa, J. (2020). Mild Systemic Hypothermic Circulatory Arrest Using a Frozen Elephant Trunk Graft with Endo-Balloon Occlusion for Total Arch Replacement. The Heart Surgery Forum, 23(5), E673-E676. https://doi.org/10.1532/hsf.3135

Issue

Section

Articles