Background
Circulatory arrest has been identified as an independent risk factor related to postoperative
mortality in patients with Stanford type A aortic dissection. This study described
a modified technique for distal aortic arch occlusion that markedly shortened the
circulatory arrest time. The early results are encouraging.
Methods
From May 2016 to September 2018, 51 patients with Stanford type A aortic dissection
underwent the modified procedure for aortic arch replacement. All operations were
performed via transitory circulatory arrest by clamping the distal aorta between the
left common carotid artery and the left subclavian artery. The in-hospital and follow-up
data of the treated patients were investigated.
Results
Successful repair of the involved vasculature was achieved in all patients. One (1)
patient died due to postoperative aspiration and infection, and three patients required
continuous renal replacement therapy due to poor preoperative renal function. The
remaining patients were successfully discharged. The median average circulatory arrest
time was 5.0 (3.0–6.0) minutes. No cases of tracheotomy, delayed closure, secondary
thoracotomy, or other complications occurred. During the follow-up period of 2.4–18.6
months, the implanted grafts and stented elephant trunks were all fully open and not
kinked.
Conclusions
A modified distal aortic arch occlusion can considerably shorten the duration of circulatory
arrest. Current experience suggests that this approach can serve as a feasible alternative
for patients during aortic arch replacement because of its simplicity and satisfactory
clinical effects.
Keywords
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Article info
Publication history
Published online: May 10, 2020
Accepted:
March 11,
2020
Received in revised form:
February 12,
2020
Received:
July 1,
2019
Identification
Copyright
© 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
