Aortic and Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
J Cardiothorac Surg. 2021 Sep 8;16(1):256. doi: 10.1186/s13019-021-01643-3.
Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 min, which increases the surgical risk. We invented an aortic balloon occlusion (ABO) technique that requires 5 min of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study.
This retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of ABO group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during in-hospital stay were also recorded.
The 30-day mortality rates were similar between ABO group (4.6%) and conventional group (7.8%, P = 0.241). Multivariate analysis showed ABO reduced postoperative acute kidney injury (23.1% vs. 35.7%, P = 0.013) and hepatic injury (12.3% vs. 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs. 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge.
The ABO achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay.
全主动脉弓置换术（TAR）联合冰冻象鼻技术（FET）需要低温循环停止（HCA）20 分钟，这增加了手术风险。我们发明了一种主动脉球囊阻断（ABO）技术，该技术平均需要 5 分钟的 HCA 即可完成 TAR 联合 FET，本研究旨在探讨这种新方法的可能优势。
本回顾性研究纳入了 2017 年 8 月至 2019 年 2 月期间在阜外医院接受 TAR 和 FET 的连续患者（ABO 组 130 例，常规组 230 例）。除了术后并发症外，还记录了住院期间血常规检查、丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）的变化。
ABO 组和常规组的 30 天死亡率相似（4.6%比 7.8%，P=0.241）。多因素分析显示，ABO 降低了术后急性肾损伤（23.1%比 35.7%，P=0.013）和肝损伤（12.3%比 27.8%，P=0.001）的发生率，同时为患者节省了费用（25.5 比 24.9 千美元，P=0.298）。我们还发现，AST 在重症监护病房（ICU）期间升高，在出院前恢复正常，而 ALT 在 ICU 期间不如 AST 高，但在出院前呈上升趋势。血小板计数在术后第 3 天呈上升趋势，在出院前可能超过术前值。
ABO 实现了 TAR 联合 FET 的手术目标，并且在住院期间的恢复过程得到了改善。
