TY - JOUR AU - Bhamidipati, Castigliano Murthy AU - Pal, Jay D PY - 2020/03/09 Y2 - 2024/03/28 TI - Early Results of a Novel Single-Stage Hybrid Aortic Arch Replacement Technique to Reduce Bypass and Circulatory Arrest Duration JF - The Heart Surgery Forum JA - HSF VL - 23 IS - 2 SE - DO - 10.1532/hsf.2831 UR - https://journal.hsforum.com/index.php/HSF/article/view/2831 SP - E107-E113 AB - <p><strong>ABSTRACT</strong></p><p><strong>Objective:</strong>&nbsp;Hybrid repair procedures of the aortic arch have been utilized to reduce surgical risks and apply this therapy to patients who would not traditionally be candidates for open surgical repair. &nbsp;We present a variation on the frozen elephant trunk technique to further reduce cardiopulmonary bypass and circulatory arrest duration.</p><p><strong>Methods:</strong>&nbsp;After initiation of cardiopulmonary bypass and during systemic cooling, a wire is advanced from the femoral artery into the aortic arch. &nbsp;In the case of aortic dissection, intravascular ultrasound is used to confirm true lumen placement. &nbsp;Under circulatory arrest, the proximal aortic arch is resected and the wire externalized. &nbsp;Antegrade deployment of a stent graft is performed into the aortic arch and proximal descending aorta. &nbsp;The ascending aortic graft is sewn to the cut end of the aorta, incorporating the stent graft. &nbsp;The graft is cannulated and cardiopulmonary bypass reinitiated. &nbsp;The remainder of the arch replacement is performed during re-warming.</p><p><strong>Results:</strong>&nbsp;Twenty two patients underwent this novel hybrid arch replacement procedure for aortic pseudoaneurysm, aortic dissection, or aneurysm. &nbsp;In comparison to the frozen elephant trunk procedure, where a dacron graft is inserted into the descending aorta, and later fixed with an endograft, this technique allows for immediate distal fixation. &nbsp;In the case of aortic dissection, there is immediate expansion of the true lumen with distal seal, potentially obviating the need for additional procedures. &nbsp;Mean duration of follow up is 12 months (range 1 – 14 months). &nbsp;The mean duration of cardiopulmonary bypass was 109.32 ±3.14 minutes. &nbsp;The mean duration of circulatory arrest was 18.00 ±1.33 minutes at a mean temperature of 23.64 ±0.58 degrees Celsius. &nbsp;There were no mortalities, no permanent disabling strokes, and no renal failure (requiring dialysis).</p><p><strong>Conclusions:</strong>&nbsp;This novel hybrid technique for aortic arch replacement is safe, significantly reduces cardiopulmonary bypass and circulatory arrest times, and is performed readily without need for fluoroscopy. &nbsp;In patients with thoracoabdominal aneurysms, the stent graft can be used as an elephant trunk for further thoracoabdominal aneurysm repair or branched thoracic endovascular aortic repair procedures.</p><p>&nbsp;</p> ER -