Effect of distal aortic arch occlusion in total arch replacement and stent-graft elephant trunk surgery for patients with acute type A aortic dissection
Objective To observe the therapeutic effect of distal aortic arch occlusion on patients with acute type A aortic dissection undergoing total arch replacement and stent-graft elephant trunk surgery.Methods Twenty-one pa-tients with acute type A aortic dissection all underwent total arch replacement and stent-graft elephant trunk surgery.Dur-ing the surgery,the distal aortic arch occlusion technique was used to block the aortic arch,with the circulatory arrest tem-perature at 28℃ moderate hypothermia.Results All 21 patients successfully completed the surgical treatment,with an average surgical duration of(8.2±1.8)h,including an intraoperative circulatory arrest time of(4.5±0.8)min,selec-tive cerebral perfusion time of(42.5±9.6)min,intraoperative extracorporeal circulation time of(206.8±16.6)min,and aortic cross-clamp time of(135.7±22.0)min.Among the 21 patients,19 were discharged after recovery,while 2 died postoperatively.Of the 19 patients who were discharged,2 experienced postoperative complications:one required bedside hemofiltration for acute renal failure,and one underwent re-thoracotomy for postoperative bleeding.Among the 2 patients who died postoperatively,one died from a coronary event,and the other from septic shock due to infection.Follow-up aortic CTA scans for the 19 discharged patients showed that the stent grafts were patent,with no signs of clamp injury,deformation,or torsion.There was no leakage near the distal anastomosis,and complete thrombosis of the false lumen at the stent graft implantation site was observed in 7 cases,partial thrombosis in 11 cases,and complete thrombosis of the en-tire descending thoracic and abdominal aorta in 1 case.Conclusion In the process of total arch replacement and stent-graft elephant trunk surgery for acute type A aortic dissection,the use of distal aortic arch occlusion technique to block the aortic arch can avoid profound hypothermic circulatory arrest,effectively reduce the duration of intraoperative circulatory arrest,and contribute to the decrease of postoperative complications.
arch blocking techniquedistal aortic arch occlusion techniquetotal arch replacementstent-graft el-ephant trunk surgerymoderate hypothermic circulatory arrestacute type A aortic dissection
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