Key result
The aortic balloon occlusion technique resulted in a 30-day mortality of 4.6% versus 10.8% for the conventional approach (p=0.063), and significantly reduced postoperative renal and hepatic injury.
Why the study?
Total aortic arch replacement with frozen elephant trunk surgery carries higher risks than isolated proximal reconstructions, prompting the application of an aortic balloon occlusion technique to reduce circulatory arrest time and improve clinical outcomes.
Does the aortic balloon occlusion technique improve clinical outcomes in patients undergoing total aortic arch replacement with frozen elephant trunk surgery?
Cohort (n=360)
No
Does the aortic balloon occlusion technique improve clinical outcomes in patients undergoing total aortic arch replacement with frozen elephant trunk surgery?
Absolute Event Rate: 4.6% vs 10.8%
p-value: p=0.063
The aortic balloon occlusion technique during total aortic arch replacement with frozen elephant trunk surgery may reduce postoperative complications such as renal and hepatic injury compared to the conventional approach.
ABO linked to less renal/hepatic injury but not lower mortality after matching; hypothesis-generating and should not yet change practice.
Background: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) surgery provides improved long-term results, but the surgery itself is associated with higher risks compared with isolated proximal reconstructions. We applied an aortic balloon occlusion (ABO) technique to reduce the circulatory arrest (CA) time and improve other clinical outcomes. Methods: All patients who underwent TAR with FET surgery (130 with ABO technique, 230 with the conventional approach) in Fuwai Hospital from August 2017 to February 2019 were reviewed in this retrospective observational cohort study. Intra- and early-postoperative results and clinical characteristics were analyzed. Results: After 1:1 propensity score matching (130 cases in each group), the 30-day mortality of the ABO group and the conventional group were 4.6% and 10.8% (p = 0.063), respectively. Although the reduction in complications was not statistically significant, the complication rate in the ABO group was relatively low, having fewer cases of postoperative renal (23.1 vs. 38.5%, p = 0.007) and hepatic (12.3 vs. 30.0%, p < 0.001) injury, lower postoperative wake-up time (15.2 ± 23.6 h vs. 20.1 ± 26.5 h, respectively, p < 0.001), reduced chest tube output (176.03 ± 143.73 ml vs. 213.29 ± 130.12 ml, respectively, p = 0.003), lower red blood cell transfusion volume (4.98 ± 6.53 u vs. 7.28 ± 10.41 u, respectively, p = 0.008), and no fatal events. Conclusions: The ABO technique is a simple method that can reduce the CA time and improve the recovery stage following TAR with FET surgery. The technique represents a practical strategy to treat patients with high operative risks due to its lower complication rate compared with the conventional approach.
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Wang et al. (2021) conducted a cohort in Aortic dissection (n=360). Aortic balloon occlusion technique vs. Conventional approach was evaluated on 30-day mortality (p=0.063). The aortic balloon occlusion technique resulted in a 30-day mortality of 4.6% versus 10.8% for the conventional approach (p=0.063), and significantly reduced postoperative renal and hepatic injury.