The arch-clamping technique during total arch replacement with frozen elephant trunk reduced circulatory arrest time to approximately 4 minutes by allowing early resumption of lower body perfusion.
Does the arch-clamping technique improve perfusion management during total arch replacement with frozen elephant trunk?
The arch-clamping technique during total arch replacement with frozen elephant trunk reduces circulatory arrest time to approximately 4 minutes, potentially improving perfusion management.
A technique called arch-clamping was used at our institute to ensure perfusion of the lower body and brain during total arch replacement with frozen elephant trunk (TAR and FET). The aortic arch clamp is inserted between the left common carotid artery and the left subclavian artery after inserting the stented elephant trunk into the true lumen of the descending aorta during the procedure, and then clamps the aorta and graft together as the distal anastomotic edge of the aorta. After the arch clamp was in place, lower body perfusion was resumed through the femoral artery was resumed and time to circulatory arrest was reduced to approximately 4 min. Cardiopulmonary bypass (CPB) flow was gradually restored to full rate. Thereafter, the left carotid artery anastomosis was completed and rewarming began. Finally, during the rewarming period, other branches of the aortic arch and ascending aorta were reconstructed. In this paper, we describe the perfusion management strategy, discuss intraoperative monitoring parameters, and examine the feasibility of the technique from a perfusion perspective.
Luo et al. (2022) studied Total arch replacement with frozen elephant trunk. Arch-clamping technique was evaluated. The arch-clamping technique during total arch replacement with frozen elephant trunk reduced circulatory arrest time to approximately 4 minutes by allowing early resumption of lower body perfusion.