Modified aortic root anastomosis and the frozen elephant trunk technique using an integrated tetra-furcate graft to repair type A aortic dissection
Background: Surgery is the preferred treatment for acute Stanford type A aortic dissection (STAAD); however, due to the complexity of the procedure, cardiac ischaemia and cardiopulmonary bypass (CPB) time are longer than general heart surgery, leading to complications. In this present study, we used...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Asian Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958423017803 |
| _version_ | 1797328783092482048 |
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| author | Jianxian Xiong Jianfeng Gao Xiangkun Zhong Wenbo Yu Wentong Li Yanyu Duan Ziyou Liu Junjian Yu |
| author_facet | Jianxian Xiong Jianfeng Gao Xiangkun Zhong Wenbo Yu Wentong Li Yanyu Duan Ziyou Liu Junjian Yu |
| author_sort | Jianxian Xiong |
| collection | DOAJ |
| description | Background: Surgery is the preferred treatment for acute Stanford type A aortic dissection (STAAD); however, due to the complexity of the procedure, cardiac ischaemia and cardiopulmonary bypass (CPB) time are longer than general heart surgery, leading to complications. In this present study, we used an integrated tetra-furcate graft for both modified aortic root and distal arch anastomoses (frozen elephant trunk technique, [FET]), and investigated postoperative outcomes associated with this technique in patients with STAAD. Methods: We included a total of 140 patients who underwent total arch replacement and FET between January 2019 and June 2022 in the present study, 41 patients who underwent the modified technique, and 99 who underwent the graft eversion technique. We subsequently analyzed the perioperative outcomes to compare the differences between the two techniques. Results: There were no statistically significant differences between the two groups in regards to the preoperative characteristics; however, the intraoperative CPB, cardiac ischaemia, and operation times of the modified technique group were significantly shorter than those of the eversion technique group (P = 0.02, P = 0.01, and P = 0.04, respectively), as were postoperative hypoxaemia, intensive care unit (ICU) stay, and ventilation times (P = 0.04, P = 0.03, and P = 0.04, respectively). Additionally, the degree of postoperative bilirubin elevation was milder in the modified technique group (P = 0.002 for direct bilirubin and P = 0.01 for indirect bilirubin). Conclusions: The modified anastomosis technique can significantly shorten CPB, cardiac ischemia, and operation times, and reduce the intraoperative FFP transfusion and postoperative hypoxemia times. This modified technique, therefore, is worth utilizing for patients with STAAD. |
| first_indexed | 2024-03-08T06:57:16Z |
| format | Article |
| id | doaj.art-cad17e25af1b460ca21012796c3a1fde |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-03-08T06:57:16Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-cad17e25af1b460ca21012796c3a1fde2024-02-03T06:34:57ZengElsevierAsian Journal of Surgery1015-95842024-02-01472982989Modified aortic root anastomosis and the frozen elephant trunk technique using an integrated tetra-furcate graft to repair type A aortic dissectionJianxian Xiong0Jianfeng Gao1Xiangkun Zhong2Wenbo Yu3Wentong Li4Yanyu Duan5Ziyou Liu6Junjian Yu7Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, People's Republic of ChinaThe First Clinical Medical College, Gannan Medical University, Ganzhou, 341000, People's Republic of ChinaThe First People's Hospital of Nankang District, Ganzhou, 341000, People's Republic of ChinaThe First Clinical Medical College, Gannan Medical University, Ganzhou, 341000, People's Republic of ChinaDepartment of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, People's Republic of ChinaKey Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, 341000, People's Republic of ChinaDepartment of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, People's Republic of China; Corresponding author. Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, People's Republic of China.Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, People's Republic of China; Corresponding author. Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, People's Republic of China.Background: Surgery is the preferred treatment for acute Stanford type A aortic dissection (STAAD); however, due to the complexity of the procedure, cardiac ischaemia and cardiopulmonary bypass (CPB) time are longer than general heart surgery, leading to complications. In this present study, we used an integrated tetra-furcate graft for both modified aortic root and distal arch anastomoses (frozen elephant trunk technique, [FET]), and investigated postoperative outcomes associated with this technique in patients with STAAD. Methods: We included a total of 140 patients who underwent total arch replacement and FET between January 2019 and June 2022 in the present study, 41 patients who underwent the modified technique, and 99 who underwent the graft eversion technique. We subsequently analyzed the perioperative outcomes to compare the differences between the two techniques. Results: There were no statistically significant differences between the two groups in regards to the preoperative characteristics; however, the intraoperative CPB, cardiac ischaemia, and operation times of the modified technique group were significantly shorter than those of the eversion technique group (P = 0.02, P = 0.01, and P = 0.04, respectively), as were postoperative hypoxaemia, intensive care unit (ICU) stay, and ventilation times (P = 0.04, P = 0.03, and P = 0.04, respectively). Additionally, the degree of postoperative bilirubin elevation was milder in the modified technique group (P = 0.002 for direct bilirubin and P = 0.01 for indirect bilirubin). Conclusions: The modified anastomosis technique can significantly shorten CPB, cardiac ischemia, and operation times, and reduce the intraoperative FFP transfusion and postoperative hypoxemia times. This modified technique, therefore, is worth utilizing for patients with STAAD.http://www.sciencedirect.com/science/article/pii/S1015958423017803Type A aortic dissectionModified aortic root anastomosisIntegrated tetra-furcate graftPostoperative outcomes |
| spellingShingle | Jianxian Xiong Jianfeng Gao Xiangkun Zhong Wenbo Yu Wentong Li Yanyu Duan Ziyou Liu Junjian Yu Modified aortic root anastomosis and the frozen elephant trunk technique using an integrated tetra-furcate graft to repair type A aortic dissection Asian Journal of Surgery Type A aortic dissection Modified aortic root anastomosis Integrated tetra-furcate graft Postoperative outcomes |
| title | Modified aortic root anastomosis and the frozen elephant trunk technique using an integrated tetra-furcate graft to repair type A aortic dissection |
| title_full | Modified aortic root anastomosis and the frozen elephant trunk technique using an integrated tetra-furcate graft to repair type A aortic dissection |
| title_fullStr | Modified aortic root anastomosis and the frozen elephant trunk technique using an integrated tetra-furcate graft to repair type A aortic dissection |
| title_full_unstemmed | Modified aortic root anastomosis and the frozen elephant trunk technique using an integrated tetra-furcate graft to repair type A aortic dissection |
| title_short | Modified aortic root anastomosis and the frozen elephant trunk technique using an integrated tetra-furcate graft to repair type A aortic dissection |
| title_sort | modified aortic root anastomosis and the frozen elephant trunk technique using an integrated tetra furcate graft to repair type a aortic dissection |
| topic | Type A aortic dissection Modified aortic root anastomosis Integrated tetra-furcate graft Postoperative outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S1015958423017803 |
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