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.

中文翻译：

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主动脉弓置换过程中改良的远端主动脉弓阻塞。

背景

循环停搏已被确定为与斯坦福A型主动脉夹层患者术后死亡率相关的独立危险因素。这项研究描述了远端主动脉弓闭塞的改良技术，可显着缩短循环停搏时间。早期结果令人鼓舞。

方法

从2016年5月到2018年9月，对51例斯坦福A型主动脉夹层患者进行了改良的主动脉弓置换手术。所有手术均通过将远端主动脉夹在左颈总动脉和左锁骨下动脉之间，通过短暂性循环停止进行。研究了所治疗患者的住院和随访数据。

结果

所有患者均成功修复了受累血管。一（1）例患者因术后抽吸和感染而死亡，三例患者因术前肾功能不佳而需要连续进行肾脏替代治疗。其余患者已成功出院。中位平均循环停搏时间为5.0（3.0–6.0）分钟。没有发生气管切开术，延迟闭合，继发性开胸手术或其他并发症的情况。在2.4-18.6个月的随访期间，植入的移植物和带支架的象鼻都完全张开并且没有扭结。

结论

改良的远端主动脉弓闭塞可大大缩短循环骤停的持续时间。目前的经验表明，这种方法由于其简单性和令人满意的临床效果，可以在主动脉弓置换术中作为患者的可行替代方案。