Aortic balloon occlusion technique in total arch replacement with frozen elephant trunk after thoracic endovascular aortic repair

BACKGROUND: Total arch replacement (TAR) with frozen elephant trunk (FET) was challenging in patients with prior thoracic endovascular aortic repair (TEVAR), for complicated arch pathology and anatomy. In this study, we aimed to present our experiences in TAR with FET after prior TEVAR, and compare the clinical outcomes between the aortic balloon occlusion technique and the conventional technique. METHODS: Between January 2016 and December 2019, 30 patients with prior TEVAR received TAR with FET in our hospital. The aortic balloon occlusion technique was applied in 9 patients, and the conventional technique in 21 patients. The median time interval from TEVAR to reoperation was 9 months (0–168 months). The indications for TAR with FET included retrograde type A aortic dissection, endoleak, arch false aneurysm and new ascending dissection. RESULTS: The patients with the balloon occlusion technique had shorter cardiopulmonary bypass time than patients with the conventional technique (151.2±31.3 vs. 183.4±46.8 min, P=0.036). The aortic-clamp time was also shorter in the balloon occlusion group, but without significant difference. The hypothermia circulatory arrest duration was significantly decreased in the balloon occlusion group (5.7±4.1 vs. 21.6±7.5 min, P<0.001). The incidence of major adverse events was 13.3%, and the mortality was 6.7%. No significant differences in the incidence of major adverse events, and the mortality were noted between the two groups. Follow-up was available in 28 survivors. The mean follow-up time was 25.4±13.0 months. No late death, aortic reoperation and complications occurred during follow-up. CONCLUSIONS: TAR with FET was a safe and effective procedure in patients with prior TEVAR, with satisfactory early and late outcomes. The aortic balloon occlusion technique could be applied in these patients, and may provide some protective effects.