Risk factor analysis of clinical outcomes of total aortic arch replacement and frozen elephant trunk with aortic balloon occlusion

Journal of Cardiothoracic Surgery

Yunfeng Li¹  Xiaogang Sun¹  Luchen Wang¹  Yaojun Dun¹ 

[1]Aortic and Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, 100037, Xicheng District, Beijing, China

关键词: Total aortic arch replacement;    Frozen elephant trunk;    Hypothermic circulatory arrest;    Aortic balloon occlusion;    Hepatic transaminase;    Blood transfusion;   

DOI  :  10.1186/s13019-021-01643-3

来源: Springer

【 摘 要 】

BackgroundTotal aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 min, which increases the surgical risk. We invented an aortic balloon occlusion (ABO) technique that requires 5 min of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study.MethodsThis retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of ABO group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during in-hospital stay were also recorded.ResultsThe 30-day mortality rates were similar between ABO group (4.6%) and conventional group (7.8%, P = 0.241). Multivariate analysis showed ABO reduced postoperative acute kidney injury (23.1% vs. 35.7%, P = 0.013) and hepatic injury (12.3% vs. 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs. 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge.ConclusionsThe ABO achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay.

【 授权许可】

CC BY