Aortic balloon occlusion technique versus moderate hypothermic circulatory arrest with antegrade cerebral perfusion in total arch replacement and frozen elephant trunk for acute type A aortic dissection

Yanxiang Liu; Yi Shi; Hongwei Guo; Cuntao Yu; Xiangyang Qian; Wei Wang; Xiaogang Sun

doi:10.1016/j.jtcvs.2019.08.074

Aortic balloon occlusion technique versus moderate hypothermic circulatory arrest with antegrade cerebral perfusion in total arch replacement and frozen elephant trunk for acute type A aortic dissection

J Thorac Cardiovasc Surg. 2021 Jan;161(1):25-33. doi: 10.1016/j.jtcvs.2019.08.074. Epub 2019 Oct 4.

Authors

Yanxiang Liu¹, Yi Shi¹, Hongwei Guo¹, Cuntao Yu¹, Xiangyang Qian¹, Wei Wang², Xiaogang Sun³

Affiliations

¹ Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: weiwanglyx@163.com.
³ Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: xiaogangsunl@163.com.

PMID: 32169371
DOI: 10.1016/j.jtcvs.2019.08.074

Abstract

Background: Moderate hypothermic circulatory arrest (MHCA) with antegrade cerebral perfusion (ACP) is safe and efficient in total arch replacement (TAR) and frozen elephant trunk (FET) for acute type A aortic dissection (ATAAD). Complications related to hypothermia and ischemia are inevitable, however. The aortic balloon occlusion (ABO) technique is performed to elevate the lowest nasopharyngeal temperature to 28°C and shorten the circulatory arrest time. In this study, we aimed to evaluate the efficacy of this new technique.

Methods: We reviewed the clinical data of patients with ATAAD who underwent TAR and FET, including 79 who underwent ABO and 109 who underwent MHCA/ACP.

Results: Circulatory arrest time was significantly lower in the ABO group compared with the MHCA/ACP group (mean, 4.8 ± 1.2 minutes vs 18.4 ± 3.1 minutes; P < .001). The composite endpoint was comparable in the 2 groups (11.4% for ABO vs 13.8% for MHCA/ACP; P = .631). Fewer patients in the ABO group developed high-grade acute kidney injury (AKI) according to a modified RIFLE criterion (22.8% vs 36.7%; P = .041), and the rate of hepatic dysfunction was lower in the ABO group (11.4% vs 28.4%; P = .005). Multivariable logistic analysis showed that the ABO technique is protective against duration of ventilation >24 hours (odds ratio [OR], 0.455; 95% confidence interval [CI], 0.234-0.887; P = .021), hepatic dysfunction (OR, 0.218; 95% CI, 0.084-0.561; P = .002), and grade II-III AKI (OR, 0.432; 95% CI, 0.204-0.915; P = .028).

Conclusions: The ABO technique significantly shortens the circulatory arrest time in TAR and FET. Available clinical data suggest that it has a certain protective effect on the liver and kidney. Future large-sample studies are warranted to thoroughly evaluate this new technique.

Keywords: aortic balloon occlusion; aortic dissection; frozen elephant trunk; total arch replacement.