Evolving Frozen Elephant Trunk Surgery: A Technique That Avoids Hypothermia And Circulatory Arrest
Marco Di Eusanio1, Paolo Berretta1, Mariano Cefarelli1, Jacopo Alfonsi1, Emanuele Gatta2
1Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy, 2Vascular Surgery Dept., Lancisi Cardiovascular Center, Ancona, Italy
Background. Over the last decade, thanks to important advances in surgical techniques and methods of end-organ protection, clinical results after Frozen Elephant Trunk (FET) surgery have progressively improved. However, prolonged extra-corporeal circulation (ECC) time and hypothermic circulatory arrest (HCA) continue to affect patients’ clinical outcomes. Here we present a modified FET technique that contemplates normothermic ECC and avoids HCA Methods. Both the innominate and the femoral artery are cannulated for ECC arterial inflow. An endograft is retrogradely deployed in zone 2 with appropriate distal sealing. Normothermic ECC is initiated and the left subclavian and carotid artery are cannulated for antegrade selective cerebral perfusion. The ascending aorta is clamped and cardioplegic arrest is obtained. Afterwards, the proximal endograft is retrogradely occluded using a balloon catheter keeping the lower body perfused from the femoral artery; the innominate artery is clamped proximally and the aortic clamp is removed. The distal anastomosis between a 4-branched vascular graft and the endograft is performed. The vascular graft is clamped, the balloon deflated and the arch reconstruction completed as usual. Results. The procedure was performed in 4 patients (mean age 77 years, Euroscore II 5.4%). Surgical indications included degenerative aneurysm (n=2) and type I endoleak (n=2). No hospital death, neurologic or renal complications were observed and the postoperative course was uneventful in all cases. Conclusions. By completely avoiding HCA, the presented normothermic FET technique aims to further improve clinical outcomes in patients undergoing arch surgery. However, a larger experience is necessary to validate our favorable initial results.
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