Aortic Arch-clamping Technique in Total Arch Replacement and Frozen Elephant Trunk for Acute Type A Aortic Dissection

Abstract

Abstract OBJECTIVES Moderate hypothermic circulatory arrest (MHCA) with selective antegrade cerebral perfusion (SACP) is safe and efficient in total arch replacement and frozen elephant trunk (TAR and FET) for acute type A aortic dissection (ATAAD). But complications related to hypothermia and ischemia are inevitable. The aortic Arch-clamping technique is performed to elevate the lowest nasopharyngeal temperature to 28℃ and shorten the circulatory arrest time. The aim is to evaluate the efficacy of this new technique. METHODS From December 2019 to May 2022, the clinical data of patients with ATAAD who underwent TAR and FET was reviewed, including Arch-clamping in 54 cases and MHCA/SACP in 149 cases. RESULTS Circulatory arrest time was significantly decreased in the aortic Arch-clamping group (4.09 ± 1.696 min vs. 23.94 ± 6.738 min, P < 0.001). The composite endpoint was comparable in the two groups (24.1% for Arch-clamping group vs. 28.9% for MHCA/SACP, P = 0.503). In the Arch-clamping group, fewer patients developed high-grade acute kidney injury (AKI) according to a modified RIFLE criterion (14.9% vs. 46.9%, P = 0.022), and the hepatic dysfunction occurrence was decreased (7.4% vs. 22.8%, P = 0.013). Multivariable logistic analysis showed that the Arch-clamping technique is a protective factor for hepatic dysfunction (OR, 0.271; 95% CI, 0.091–0.803; p = 0.019), and Grade II & III AKI (OR, 0.393; 95% CI, 0.164–0.944; p = 0.037). CONCLUSIONS Arch-clamping technique shortens the circulatory arrest time significantly in TAR and FET. Available clinical data suggested that it has a certain protective effect on systemic organs and promotes postoperative recovery. Future large-sample studies are warranted to thoroughly examine this new technique.