Total Debranching Hybrid Total Arch Replacement With A Novel Frozen Elephant Trunk For Acute Aortic Dissection Type A
Hiroyuki Kamiya1, Sentaro Nakanishi1, Hayato Ise1, Hiroto Kitahara1, Natsuya Ishikawa1, Naohiro Wakabayashi1, Hug Aubin2, Artur Lichtenberg2, Payam Akhyari2.
1Asahikawa Medical University, Asahikawa, Japan, 2Duesseldorf University Hospital, Duesseldorf, Germany.
Objective For acute aortic dissection type A (AADA) with large patent false lumen, total arch replacement (TAR) may be desirable to prevent acute visceral malperfusion and down-stream aortic event in the late phase. We simplify and minimize the risk of the procedure by utilizing total debranching method, which is often performed concomitant with thoracic endovascular aortic repair. Methods This is a retrospective single center study. From November 2017 to May 2018, consecutive 5 patients who underwent TAR with total debranching of the supra-aortic vessels and a novel frozen elephant trunk technique for AADA were reviewed. Immediately after median sternotomy, total debranching of the right carotid, left carotid and left axillary artery was performed with quadrifurcated graft. TAR was performed under moderate hypothermia with true lumen perfusion through the debranching graft. A frozen elephant trunk was inserted into the aortic arch, following closure of the orifice of the supra-aortic vessels. The ascending aorta was replaced with one-branch graft. Finally, the quadrifurcated graft was anastomosed to the graft. Results The procedure was successfully performed in all patients. Preoperative arch vessel malperfusion was observed in 4 patients. One patient had preoperative neurological symptom. The mean clamp time of the right carotid, left carotid, and left axillary artery was 12.4 ± 2.3, 13.1 ± 4.1, and 20.7 ± 6.5 minutes respectively. The mean change of regional cerebral oxygen saturation (rSO2) during clamp of right/left carotid artery was 9.7 ± 4.5 on the right side, and 13.7 ± 5.1 on the left side. The rSO2 values before and after clamp were statistically similar. After total debranching, there were no significant rSO2 changes through the procedure. The mean operative, cardiopulmonary bypass, and selective cerebral perfusion time was 443.1 ± 123.8, 152.7 ± 57.0, and 34.9 ± 10.4 minutes. There was no postoperative neurological complication. There was no 30-day mortality. Conclusions Total debranching of the supra-aortic vessels with a novel frozen elephant trunk technique would facilitate TAR for AADA with minimizing the risk of procedure and obtaining optimal brain protection. Figure Legend Postoperative 3D-CT imaging. 
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