Early and mid-term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aor
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ORIGINAL ARTICLE
Early and mid‑term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aortic dissection Yu Hohri1 · Takuma Yamasaki1 · Yuichi Matsuzaki1 · Takeshi Hiramatsu1 Received: 30 November 2019 / Accepted: 26 February 2020 © The Author(s) 2020
Abstract Objective This study aimed to evaluate the prevalence of spinal cord injury in total arch replacement with frozen elephant trunk for acute type A aortic dissection using our spinal cord protection technique. Methods Between January 2013 and December 2017, 33 patients underwent total arch replacement with frozen elephant trunk for acute type A aortic dissection (mean age 67.9 ± 13.3 years). Our spinal cord protection technique involved maintaining extracorporeal circulation through the left subclavian artery in all procedures, using aortic occlusion balloon during distal anastomosis, and inserting frozen elephant trunk above Th 8 with transesophageal echocardiographic guidance. Computed tomography was performed within 1–2 weeks, 12 months, and 36 months postoperatively. We compared the degree of thrombosis of the descending aorta between preoperation and early postoperative period by Fisher’s exact test. Moreover, we evaluated postoperative mortality and mobility (including spinal cord injury) at follow-up. Results The operative mortality within 30 days was 6.1%. Neither paraplegia nor paraparesis was noted. We observed significant thrombosis of the false lumen at the distal arch and aortic valve level of the descending aorta in postoperative early term period (p 85 years), DeBakey classification type II, and inability to receive extended anticoagulant treatment because of risk of hemorrhagic cerebral infarction.
Methods The chief surgeon (Takuma Yamasaki) performed the surgery in all patients. All procedures involved implantation of a J Graft Open Stent Graft or J Graft FROZENIX (Japan Lifeline, Tokyo, Japan) into the descending aorta. The primary entry tear was observed with preoperative contrast-enhanced CT or intraoperative visual inspection. Our hospital’s ethics committee approved this retrospective study; informed consent was obtained from patients prior to surgery. Moreover, this study was conducted in accordance with the principles outlined in the Declaration of Helsinki and all its provisions.
TAR‑FET procedure Extracorporeal circulation during TAR-FET is shown in Fig. 1. A median sternotomy was employed for all TAR-FET procedures. Two arterial perfusion cannulas were inserted into the left subclavian and unilateral femoral arteries anastomosed to a 9-mm synthetic graft. A right subclavian artery cannula was additionally inserted in patients with right cerebral malperfusion. A two-stage venous cannula was inserted through the right atrium, and a left ventricular vent tube was inserted through the right upper pulmonary vein (Fig. 1a). The ascending aorta was clamped and incised. The proximal
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General Thoracic and Cardiovascular Surgery
aortic stump was covered with inner and outer felt strips
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