The efficacy of aortic arch 1 zone clamping technique in the procedure of ascending aortic aneurysm involving the proximal aortic arch_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BAO Chunrong , WEI Ke , MEI Ju , ZHANG Yunjiao , ZHANG Li ,  MA Nan

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P. R. China;

Corresponding author：

MA Nan, Email: manancts@sina.com

Keywords：

Ascending aortic aneurysm; surgery; aortic arch; deep hypothermic circulatory arrest

DOI：

10.7507/1007-4848.202206057

Video：

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Objective To summarize the efficacy of aortic arch 1 zone clamping technique in the procedure of ascending aortic aneurysm involving the proximal aortic arch. Methods The clinical data of patients with ascending aortic aneurysm involving the proximal aortic arch who underwent surgical treatment with aortic arch 1 zone clamping technique in our hospital from 2017 to 2019 were retrospectively analyzed. Results A total of 35 patients were enrolled, including 21 males and 14 females, with an average age of 63.9±10.8 years. According to different lesions, the proximal aorta underwent Bentall/Carbrol procedure in 8 patients, Wheat in 4 patients, David in 3 patients, and ascending aorta replacement in 20 patients. Distal lesions were completely resected under aortic arch 1 zone clamping technique, and anastomotic reconstruction was performed under hypothermic cardiopulmonary bypass. Distal anastomosis was performed with interrupted suture in 7 patients, and continuous suture with intermittent reinforcement of the posterior wall in 28 patients. All patients successfully completed the procedure. The average cardiopulmonary bypass time was 121.5±28.2 min, the aortic clamping time was 78.1±21.3 min, and the distal anastomosis time was 15.2±3.6 min. One patient underwent a second thoracotomy for hemostasis, and the remaining patients were drained 330.6±108.1 mL on the first day following the procedure. The postoperative mechanical ventilation time of 2 patients exceeded 24 hours, and the main complications were pulmonary infection in 1 patient and acute renal injury in 2 patients. Transient delirium occurred in 2 patients and no transient or permanent neurological dysfunction occurred. The average follow-up time was 2.6±1.1 years. The maximum diameter of the ascending aorta after operation was 30.4±0.9 mm, the diameter of zone 1 aortic arch was 39.8±3.1 mm, and the diameter of the distal aortic arch was 32.3±4.3 mm. There was no lesion in the artificial blood vessels of all patients, and no aneurysms occurred at the proximal or distal anastomosis. No reoperation or intervention was needed for the aorta. Conclusion The aortic arch 1 zone clamping technique can simplify the procedure of ascending aortic aneurysm involving the proximal aortic arch, reduce or avoid the use of deep hypothermic circulatory arrest, reduce the surgical trauma, and has good short-term and medium-term efficacy.

Citation： BAO Chunrong, WEI Ke, MEI Ju, ZHANG Yunjiao, ZHANG Li, MA Nan. The efficacy of aortic arch 1 zone clamping technique in the procedure of ascending aortic aneurysm involving the proximal aortic arch. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(11): 1586-1590. doi: 10.7507/1007-4848.202206057 Copy

1.	中国生物医学工程学会体外循环分会. 2020年中国心外科手术和体外循环数据白皮书. 中国体外循环杂志, 2021, 19(5): 257-260.
2.	Silvay G, Lurie JM, Casale M. The anaesthetic management of patients with thoracic ascending aortic aneurysms: A review. J Perioper Pract, 2021, 31(7-8): 281-288.
3.	David TE. Surgical treatment of ascending aorta and aortic root aneurysms. Prog Cardiovasc Dis, 2010, 52(5): 438-444.
4.	Pearsall C, Blitzer D, Zhao Y, et al. Long-term outcome of hemiarch replacement in a proximal aortic aneurysm repair: Analysis of over 1000 patients. Eur J Cardiothorac Surg, 2022, 62(1): ezab571.
5.	Gocoł R, Hudziak D, Bis J, et al. The role of deep hypothermia in cardiac surgery. Int J Environ Res Public Health, 2021, 18(13): 7061.
6.	Lusini M, Nenna A, Chello C, et al. Role of autophagy in aneurysm and dissection of the ascending aorta. Future Cardiol, 2020, 16(5): 517-526.
7.	Lo Presti F, Guzzardi DG, Bancone C, et al. The science of BAV aortopathy. Prog Cardiovasc Dis, 2020, 63(4): 465-474.
8.	Gökalp AL, Takkenberg JJM. Decision-making in thoracic aortic aneurysm surgery-clinician and patient view. Semin Thorac Cardiovasc Surg, 2019, 31(4): 638-642.
9.	Gupta P, Harky A, Jahangeer S, et al. Varying evidence on deep hypothermic circulatory arrest in thoracic aortic aneurysm surgery. Tex Heart Inst J, 2018, 45(2): 70-75.
10.	Tveita T, Sieck GC. Physiological impact of hypothermia: The good, the bad, and the ugly. Physiology (Bethesda), 2022, 37(2): 69-87.
11.	Qu JZ, Kao LW, Smith JE, et al. Brain protection in aortic arch surgery: An evolving field. J Cardiothorac Vasc Anesth, 2021, 35(4): 1176-1188.
12.	Urbanski PP, Lenos A, Bougioukakis P, et al. Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: A change of paradigm? Eur J Cardiothorac Surg, 2012, 41(1): 185-191.
13.	Poon SS, Estrera A, Oo A, et al. Is moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion superior to deep hypothermic circulatory arrest in elective aortic arch surgery? Interact Cardiovasc Thorac Surg, 2016, 23(3): 462-468.
14.	Jormalainen M, Kesävuori R, Raivio P, et al. Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection. Interact Cardiovasc Thorac Surg, 2022, 34(3): 453-461.
15.	Lou X, Chen EP. Optimal cerebral protection strategies in aortic surgery. Semin Thorac Cardiovasc Surg, 2019, 31(2): 146-152.

1. 中国生物医学工程学会体外循环分会. 2020年中国心外科手术和体外循环数据白皮书. 中国体外循环杂志, 2021, 19(5): 257-260.
2. Silvay G, Lurie JM, Casale M. The anaesthetic management of patients with thoracic ascending aortic aneurysms: A review. J Perioper Pract, 2021, 31(7-8): 281-288.
3. David TE. Surgical treatment of ascending aorta and aortic root aneurysms. Prog Cardiovasc Dis, 2010, 52(5): 438-444.
4. Pearsall C, Blitzer D, Zhao Y, et al. Long-term outcome of hemiarch replacement in a proximal aortic aneurysm repair: Analysis of over 1000 patients. Eur J Cardiothorac Surg, 2022, 62(1): ezab571.
5. Gocoł R, Hudziak D, Bis J, et al. The role of deep hypothermia in cardiac surgery. Int J Environ Res Public Health, 2021, 18(13): 7061.
6. Lusini M, Nenna A, Chello C, et al. Role of autophagy in aneurysm and dissection of the ascending aorta. Future Cardiol, 2020, 16(5): 517-526.
7. Lo Presti F, Guzzardi DG, Bancone C, et al. The science of BAV aortopathy. Prog Cardiovasc Dis, 2020, 63(4): 465-474.
8. Gökalp AL, Takkenberg JJM. Decision-making in thoracic aortic aneurysm surgery-clinician and patient view. Semin Thorac Cardiovasc Surg, 2019, 31(4): 638-642.
9. Gupta P, Harky A, Jahangeer S, et al. Varying evidence on deep hypothermic circulatory arrest in thoracic aortic aneurysm surgery. Tex Heart Inst J, 2018, 45(2): 70-75.
10. Tveita T, Sieck GC. Physiological impact of hypothermia: The good, the bad, and the ugly. Physiology (Bethesda), 2022, 37(2): 69-87.
11. Qu JZ, Kao LW, Smith JE, et al. Brain protection in aortic arch surgery: An evolving field. J Cardiothorac Vasc Anesth, 2021, 35(4): 1176-1188.
12. Urbanski PP, Lenos A, Bougioukakis P, et al. Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: A change of paradigm? Eur J Cardiothorac Surg, 2012, 41(1): 185-191.
13. Poon SS, Estrera A, Oo A, et al. Is moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion superior to deep hypothermic circulatory arrest in elective aortic arch surgery? Interact Cardiovasc Thorac Surg, 2016, 23(3): 462-468.
14. Jormalainen M, Kesävuori R, Raivio P, et al. Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection. Interact Cardiovasc Thorac Surg, 2022, 34(3): 453-461.
15. Lou X, Chen EP. Optimal cerebral protection strategies in aortic surgery. Semin Thorac Cardiovasc Surg, 2019, 31(2): 146-152.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The efficacy of aortic arch 1 zone clamping technique in the procedure of ascending aortic aneurysm involving the proximal aortic arch

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