The strategy of cardiopulmonary bypass for total aortic arch replacement and the frozen elephant trunk technique with aortic balloon occlusion

Figures

• 

  Figure 1.. Illustration of the aortic balloon occlusion technique that was used to assist total aortic arch replacement (TAR) with the frozen elephant trunk (FET) technique to shorten the lower body circulatory arrest (CA) time and raise the nadir temperature during cardiopulmonary bypass (CPB). (a) CPB establishment. Femoral and axillary cannulations were provided from a bifurcated arterial line from one central perfusion. (b) Set up of aortic balloon occlusion apparatus terminated CA. (c) After achieving bilateral cerebral perfusion, CPB returned to target full perfusion flow and rewarming began. (d) TAR with FET operation finished before CPB withdrawal. The colour version of this figure is available at: http://imr.sagepub.com.

• 

  Figure 2.. The ratio of aortic dissection involvement in different segments and branches, expressed as percentage (%) to total cases of aortic dissection: 123 in aortic balloon occlusion group (upper value) and 221 in the conventional (lower value) total aortic arch replacement (TAR) with the frozen elephant trunk (FET) technique group. The colour version of this figure is available at: http://imr.sagepub.com.

• 

  Figure 3.. Temperature changes over time during cardiopulmonary bypass (CPB) in patients that either underwent the new aortic balloon occlusion technique that was used to assist total aortic arch replacement (TAR) with the frozen elephant trunk (FET) technique (aortic balloon occlusion group; n = 130) or TAR with FET with lower body circulatory arrest (CA) during distal aortic anastomosis (conventional group; n = 230). (a) Nasal temperature; (b) rectal temperature. Data presented as mean ± SD. The colour version of this figure is available at: http://imr.sagepub.com.

• 

  Figure 4.. Perfusion rate changes over time during cardiopulmonary bypass (CPB) in patients that either underwent the new aortic balloon occlusion technique that was used to assist total aortic arch replacement (TAR) with the frozen elephant trunk (FET) technique (aortic balloon occlusion group; n = 130) or TAR with FET with lower body circulatory arrest (CA) during distal aortic anastomosis (conventional group; n = 230). (a) Total and axillary cannulation rate in ml/min in the aortic balloon occlusion group; (b) total and axillary cannulation rate in ml/min in the conventional group; (c) total rate in ml/kg per min in both groups; (d) axillary cannulation rate in ml/kg per min in both groups. Data presented as mean ± SD. ASCP, antegrade selective cerebral perfusion. The colour version of this figure is available at: http://imr.sagepub.com.

• 

  Figure 5.. Monitored blood pressure over time during cardiopulmonary bypass (CPB) in patients that either underwent the new aortic balloon occlusion technique that was used to assist total aortic arch replacement (TAR) with the frozen elephant trunk (FET) technique (aortic balloon occlusion group; n = 130) or TAR with FET with lower body circulatory arrest (CA) during distal aortic anastomosis (conventional group; n = 230). (a) Radial artery blood pressure; (b) foot dorsal artery blood pressure. Data presented as mean ± SD. ASCP, antegrade selective cerebral perfusion; LSCA, left subclavian artery. The colour version of this figure is available at: http://imr.sagepub.com.