Abstract
BackgroundThe management of malperfusion is vital to improve the outcomes of surgery for acute type A acute aortic dissection (ATAAD). Open arch repair under hypothermic circulatory arrest with selective antegrade cerebral perfusion (HCA/sACP) is safe and efficient but associated with inevitable hypothermia and ischemia-reperfusion injury. The aortic balloon occlusion (ABO) technique is shown to be organ protective by allowing higher temperature and shorter circulatory arrest time. In this study, we aimed to evaluate the safety and efficacy of this new technique for ATAAD patients with lower body malperfusion.MethodsBetween January 2013 and November 2020, 355 ATAAD patients with lower body malperfusion who underwent arch repair in our institute were enrolled. The patients were divided into 2 groups: ABO group (n = 85) and HCA/sACP group (n = 271). Propensity score matching was performed to correct baseline differences.ResultsUsing the propensity score matching, 85 pairs were generated. Circulatory arrest time was significantly lower in the ABO group compared with the HCA/sACP group (median, 8 vs. 22 min; p < 0.001). The incidence of in-hospital mortality (10.6 vs. 12.9%; p = 0.812), stroke (7.1 vs. 7.1%; p = 1.000), dialysis (25.9 vs. 32.9%; p = 0.183), hepatic dysfunction (52.9 vs. 57.6%; p = 0.537), tracheostomy (4.7 vs. 2.4%; p = 0.682), paraplegia (1.2 vs. 4.7%; p = 0.368) were comparable between ABO and HCA/sACP groups. Other outcomes and major adverse events were comparable. The multivariable logistic analysis did not recognize ABO technique protective against any major adverse outcomes.ConclusionsFor ATAAD patients with lower body malperfusion, the ABO technique allows the performance of arch repair with frozen elephant trunk (FET) under higher temperature and shorter circulatory arrest time. However, ABO technique did not improve perioperative outcomes. Future studies are warranted to evaluate the efficacy of this technique.
Highlights
Malperfusion is a life-threatening complication of acute type A acute aortic dissection (ATAAD)
Lower body organ injuries associated with hypothermia and ischemia-reperfusion injury remain a major concern, especially for those who already suffer from malperfusion
Between January 2013 and November 2020, a total of 1,226 patients underwent arch repair for ATAAD in our institute, and a total of 355 patients were diagnosed with lower body malperfusion at admission
Summary
Malperfusion is a life-threatening complication of acute type A acute aortic dissection (ATAAD). Open-end anastomosis under hypothermic circulatory arrest in combination with selective antegrade cerebral perfusion (HCA/sACP) is the currently recommended technique for arch repair for ATAAD [4–6]. The lower body is inevitably exposed to ischemia and subsequent reperfusion injury. Lower body organ injuries associated with hypothermia and ischemia-reperfusion injury remain a major concern, especially for those who already suffer from malperfusion. The management of malperfusion is vital to improve the outcomes of surgery for acute type A acute aortic dissection (ATAAD). Open arch repair under hypothermic circulatory arrest with selective antegrade cerebral perfusion (HCA/sACP) is safe and efficient but associated with inevitable hypothermia and ischemia-reperfusion injury. The aortic balloon occlusion (ABO) technique is shown to be organ protective by allowing higher temperature and shorter circulatory arrest time. We aimed to evaluate the safety and efficacy of this new technique for ATAAD patients with lower body malperfusion
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