Key result
The branching retrograde externalized guidewire technique significantly reduced cardiopulmonary bypass time compared to the frozen elephant trunk technique, with similar 30-day mortality (8.3% vs 9.1%, P>0.999).
Why the study?
In hybrid aortic repair with root replacement and endovascular arch repair, an artificial aortic valve prosthesis might impede the endovascular procedure.
Does the BREG technique reduce cardiopulmonary bypass and cross-clamp times compared to the FET technique in high-risk patients undergoing hybrid aortic repair with aortic valve replacement?
Cohort (n=112)
Does the BREG technique reduce cardiopulmonary bypass and cross-clamp times compared to the FET technique in high-risk patients undergoing hybrid aortic repair with aortic valve replacement?
Absolute Event Rate: 8.3% vs 9.1%
p-value: p=>0.999
The BREG technique is a feasible and efficient alternative that reduces cardiopulmonary bypass and cross-clamp times in high-risk patients undergoing hybrid aortic repair with concomitant aortic valve replacement.
May facilitate hybrid aortic repair with prosthetic valves; leaves open need for comparative validation.
Background: The hybrid aortic repair consisting of root replacement and endovascular arch repair is an optimal alternative for patients unfit for circulatory arrest. However, an artificial aortic valve prosthesis might impede the endovascular procedure. This study aims to present our experience with the branching retrograde externalized guidewire (BREG) technique in such situations, and discuss its utility and efficiency. Methods: From January 2015 to June 2021, a total of 112 patients underwent aortic root/valve replacement combined with aortic arch repair. Among them, the BREG technique was adopted on 24 patients, and the traditional frozen elephant trunk (FET) technique was used for 88 patients. The indication of the BREG was as follows: high-risk patients not suitable for traditional open surgery; meanwhile, the aortic disease required extended repair, and the aortic valve needed to be replaced concomitantly. The data of the 2 groups were compared. Results: The cardiopulmonary bypass time (213.5 ± 73.6 min vs. 246.5 ± 46.2 min, P = 0.046) and cross-clamped time (109.0 ± 27.6 min vs. 139.0 ± 24.6 min, P < 0.001) were significantly shorter in the BREG group than that in the FET group. Less operative red blood cell consumption was achieved in the BREG group (6.6 ± 5.7 vs. 9.4 ± 8.0 U, P = 0.046). The 30-day mortality was similar between the 2 groups (8.3% BREG vs. 9.1% FET, P > 0.999). Conclusion: The BREG technique facilitated the advancement of endovascular stent graft, avoided impeding the aortic valve prosthesis in hybrid aortic surgery with aortic valve replacement, and may benefit high-risk patients.
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Ma et al. (2023) conducted a cohort in Aortic disease requiring extended repair and concomitant aortic valve replacement (n=112). Branching retrograde externalized guidewire (BREG) technique vs. Traditional frozen elephant trunk (FET) technique was evaluated on 30-day mortality (p=>0.999). The branching retrograde externalized guidewire technique significantly reduced cardiopulmonary bypass time compared to the frozen elephant trunk technique, with similar 30-day mortality (8.3% vs 9.1%, P>0.999).
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