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Total Arch Replacement With Frozen Elephant Trunk Using a NEW “Brain-Heart-First” Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (≥30°C) With Satisfactory Outcomes
BACKGROUND: Total arch replacement (TAR) with Frozen elephant trunk (FET) treatment of acute DeBakey type I aortic dissection (ADIAD) is complicated, carries a high complication/mortality risk and remains controversial on the optimal hypothermic level, cerebral perfusion and visceral organ protectio...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861271/ https://www.ncbi.nlm.nih.gov/pubmed/35211524 http://dx.doi.org/10.3389/fcvm.2022.806822 |
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author | Shen, Kangjun Tan, Ling Tang, Hao Zhou, Xinmin Xiao, Jun Xie, Dongshu Li, Jingyu Chen, Yichuan |
author_facet | Shen, Kangjun Tan, Ling Tang, Hao Zhou, Xinmin Xiao, Jun Xie, Dongshu Li, Jingyu Chen, Yichuan |
author_sort | Shen, Kangjun |
collection | PubMed |
description | BACKGROUND: Total arch replacement (TAR) with Frozen elephant trunk (FET) treatment of acute DeBakey type I aortic dissection (ADIAD) is complicated, carries a high complication/mortality risk and remains controversial on the optimal hypothermic level, cerebral perfusion and visceral organ protection strategy. We developed a new strategy named “Brain-Heart-first” in which the surgical procedures and the management of cardiac perfusion/cerebral protection during Cardiopulmonary bypass (CPB) were redesigned, and TAR with FET technique can be performed under mild hypothermia with satisfactory outcomes. OBJECTIVE: Our aims were to describe a new surgical strategy under mild hypothermia (≥30°C) for the treatment of ADIAD and to report the operative outcomes of 215 patients. METHODS: We conducted a retrospective analysis of 215 consecutive cases of ADIAD treated with our new strategy. RESULTS: The durations of CPB, aortic cross-clamping, antegrade cerebral perfusion, operation, mechanical ventilation support, and Intensive Care Unit stay were 139.7 ± 52.3 min, 55.6 ± 27.4 min, 14.1 ± 3.1 min, 6.0 ± 1.7 h, 40.0 h and 4.0 d, respectively. The 30-day mortality was 9.8%, with cerebral stroke occurring in nine patients (4.2%), paraplegia in one patient (0.5%) and postoperative renal injury requiring dialysis in 21 patients (9.8%). The blood transfusion of red blood cells and fresh frozen plasma during surgery and the first 24 h after surgery was 4.0 u and 200.0 ml, respectively. CONCLUSIONS: The Brain-Heart-first strategy can be widely used with low technical and resource requirements and provides a safe alternative for conventional TAR with FET technique in ADIAD patients with satisfactory operative results. |
format | Online Article Text |
id | pubmed-8861271 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-88612712022-02-23 Total Arch Replacement With Frozen Elephant Trunk Using a NEW “Brain-Heart-First” Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (≥30°C) With Satisfactory Outcomes Shen, Kangjun Tan, Ling Tang, Hao Zhou, Xinmin Xiao, Jun Xie, Dongshu Li, Jingyu Chen, Yichuan Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Total arch replacement (TAR) with Frozen elephant trunk (FET) treatment of acute DeBakey type I aortic dissection (ADIAD) is complicated, carries a high complication/mortality risk and remains controversial on the optimal hypothermic level, cerebral perfusion and visceral organ protection strategy. We developed a new strategy named “Brain-Heart-first” in which the surgical procedures and the management of cardiac perfusion/cerebral protection during Cardiopulmonary bypass (CPB) were redesigned, and TAR with FET technique can be performed under mild hypothermia with satisfactory outcomes. OBJECTIVE: Our aims were to describe a new surgical strategy under mild hypothermia (≥30°C) for the treatment of ADIAD and to report the operative outcomes of 215 patients. METHODS: We conducted a retrospective analysis of 215 consecutive cases of ADIAD treated with our new strategy. RESULTS: The durations of CPB, aortic cross-clamping, antegrade cerebral perfusion, operation, mechanical ventilation support, and Intensive Care Unit stay were 139.7 ± 52.3 min, 55.6 ± 27.4 min, 14.1 ± 3.1 min, 6.0 ± 1.7 h, 40.0 h and 4.0 d, respectively. The 30-day mortality was 9.8%, with cerebral stroke occurring in nine patients (4.2%), paraplegia in one patient (0.5%) and postoperative renal injury requiring dialysis in 21 patients (9.8%). The blood transfusion of red blood cells and fresh frozen plasma during surgery and the first 24 h after surgery was 4.0 u and 200.0 ml, respectively. CONCLUSIONS: The Brain-Heart-first strategy can be widely used with low technical and resource requirements and provides a safe alternative for conventional TAR with FET technique in ADIAD patients with satisfactory operative results. Frontiers Media S.A. 2022-02-08 /pmc/articles/PMC8861271/ /pubmed/35211524 http://dx.doi.org/10.3389/fcvm.2022.806822 Text en Copyright © 2022 Shen, Tan, Tang, Zhou, Xiao, Xie, Li and Chen. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Shen, Kangjun Tan, Ling Tang, Hao Zhou, Xinmin Xiao, Jun Xie, Dongshu Li, Jingyu Chen, Yichuan Total Arch Replacement With Frozen Elephant Trunk Using a NEW “Brain-Heart-First” Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (≥30°C) With Satisfactory Outcomes |
title | Total Arch Replacement With Frozen Elephant Trunk Using a NEW “Brain-Heart-First” Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (≥30°C) With Satisfactory Outcomes |
title_full | Total Arch Replacement With Frozen Elephant Trunk Using a NEW “Brain-Heart-First” Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (≥30°C) With Satisfactory Outcomes |
title_fullStr | Total Arch Replacement With Frozen Elephant Trunk Using a NEW “Brain-Heart-First” Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (≥30°C) With Satisfactory Outcomes |
title_full_unstemmed | Total Arch Replacement With Frozen Elephant Trunk Using a NEW “Brain-Heart-First” Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (≥30°C) With Satisfactory Outcomes |
title_short | Total Arch Replacement With Frozen Elephant Trunk Using a NEW “Brain-Heart-First” Strategy for Acute DeBakey Type I Aortic Dissection Can Be Performed Under Mild Hypothermia (≥30°C) With Satisfactory Outcomes |
title_sort | total arch replacement with frozen elephant trunk using a new “brain-heart-first” strategy for acute debakey type i aortic dissection can be performed under mild hypothermia (≥30°c) with satisfactory outcomes |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861271/ https://www.ncbi.nlm.nih.gov/pubmed/35211524 http://dx.doi.org/10.3389/fcvm.2022.806822 |
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