The beating heart technique during frozen elephant trunk total arch repair

Introduction Our aim was to evaluate the beating heart technique during frozen elephant trunk (FET) total arch replacement. Methods Between 03/2013 and 01/2023, 357 patients underwent FET total arch replacement in one aortic centre. Patient characteristics, intra- and postoperative data were compared between 290 patients (81%) undergoing FET repair during cardioplegic arrest and 67 patients (19%) operated on using the beating heart technique after propensity score matching. Results After propensity score matching there were no statistically significant differences in preoperative characteristics, the underlying pathology, and regarding arterial inflow-cannulation or concomitant cardiac procedures. Aortic cross-clamp ( p = .042) and cerebral perfusion ( p = .003) times were significantly shorter in the beating heart group. Postoperative cardiac biomarkers were lower, but the difference did not reach statistical significance. In-hospital mortality was numerically lower (1 [2%] vs 4 [7%], p = .346), and the incidence of postoperative renal replacement therapy was significantly lower ( p = .027) in the beating heart group. Usage of the beating heart technique was not a significant variable in our logistic regression model for in-hospital mortality, while an acute aortic pathology was highly predictive for the outcome ( p = .006, odds ratio: 3.319). Conclusions The beating heart technique has the potential to improve postoperative outcome following FET total arch replacement. The approach may be helpful for patients with reduced left ventricular function because of shorter aortic cross-clamp times.