Abstract
ObjectiveAortic arch replacement in acute type A aortic dissection patients remains the most challenging cardiovascular operation. Herein, we described our modified Y-graft technique using the Femoral Artery Bypass (FAB) and the One Minute Systemic Circulatory Arrest (OSCA) technique, and assessed the short-term outcomes of the patients.MethodsBetween February 2015 and November 2017, 51 patients with acute type A aortic dissection underwent aortic arch replacement. Among them, 23 patients underwent FAB while 28 patients underwent both FAB and OSCA. The intraoperative data and postoperative follow-up data were recorded. The follow-up data of patients with traditional Y-graft technique were collected from previously reported studies.ResultsIn the FAB group, two patients died due to pulmonary infection (30-day survival rate, 91.3%), and two patients were paralyzed from the waist down. Hemodialysis was performed for five patients (21.7%) before hospital discharge. Fifteen patients (65.2%) received respiratory support for more than 2-days and eight patients (34.8%) for more than 5-days. These follow-up results were comparable or better than the patients with traditional Y-graft technique. Furthermore, compared to the FAB group, the morbidity due to neurological dysfunction and acute renal failure was significantly reduced in the FAB+OSCA group. Moreover, the respiratory support, length of postoperative stay and ICU stay were shortened.ConclusionsThis study clarified the feasibility of FAB and OSCA technique in modifying Y-graft technique. The acute type A aortic dissection patients showed less surgical complications and favorable short-term outcomes after this surgery.
Highlights
The first successful aortic arch replacement was reported more than fifty years ago
The follow-up data of patients with traditional Y-graft technique were collected from previously reported studies
The results showed that the follow-up data in the patients using Femoral Artery Bypass (FAB) modified Y-graft technique were comparable or superior to the data in patients with traditional Y-graft technique
Summary
The first successful aortic arch replacement was reported more than fifty years ago. With the development of the surgical technique and the improvement of patient care, the aortic arch can be repaired more safely now. Total aortic arch replacement in acute type A aortic dissection patients remains the most challenging cardiovascular operation, which incurs high risk of cerebral damage and acute renal failure, and a considerable risk of operative mortality. In 2002, Spielvogel and colleagues developed the Ygraft technique to enable antegrade selective cerebral perfusion [2]. The individual reconstruction of brachiocephalic branches using a trifurcated graft benefitted the prognosis of the patients [3, 4]. The outcome of the aortic arch replacement surgery is largely affected by the surgeon’s skills and the tentative surgery techniques [5, 6]. Feasible and beneficial modifications of this technique are urgently needed
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