JTCVS techniques · 2025
"Head First" approach streamlines aortic arch replacement.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wu Bo Chang Brian, Rosenberg Drake S, Skalicky Meghan, Chanes Nicolas, Bell Annelise, Cain Michael T, Hoffman Jordan R H, Rove Jessica Yu, Aftab Muhammad, Reece Thomas Brett
Аннотация
OBJECTIVE: The "Head First" graft technique has emerged as a preferred approach for aortic replacement by many surgeons. This study evaluated its performance and safety, focusing on operative efficiency, cerebral protection, and its role in open arch repair outcomes.
METHODS: We reviewed 150 patients who underwent zone 2 or more extensive arch replacement using the "Head First" approach from August 2020 to March 2025. Perioperative variables were compared between patients with acute type A aortic dissection (n = 40) and elective repair (n = 84). Logistic regression identified risk factors for stroke.
RESULTS: Patients' median age was 62 [49-69] years, and 64.7% were male. A total of 44% cases were urgent/emergent; 46.7% of patients underwent redo sternotomy, and 77.3% of patients received the frozen elephant trunk procedure. Nadir temperature was 27.4 °C [26 °C-28 °C]. Overall disabling stroke and 30-day mortality were 10.7% and 16.7%, respectively. Compared with elective patients, patients with acute type A aortic dissection had longer bypass (223.5 vs 156 minutes, P < .001) and circulatory arrest (24 vs 16 minutes, P < .001), and more prolonged intubation (65% vs 26.2%, P < .001) and 30-day mortality (40% vs 6%, P < .001). Disabling stroke rates were not significantly different (17.5% vs 8.3%, P = .219), and 3-year cumulative incidence of unplanned reintervention was similar. Male gender was independently protective against stroke (adjusted odds ratio, 0.34, P = .034). In univariable analysis, diabetes was a risk factor for stroke (odds ratio, 3.84, P = .046), whereas age (odds ratio, 1.03, P = .072) and frozen elephant trunk (odds ratio, 7.29, P = .057) showed borderline associations.
CONCLUSIONS: The "Head First" approach demonstrated acceptable outcomes in complex arch replacement. It prioritizes cerebral protection, facilitates timely reconstruction with shorter circulatory arrest, and may improve technical feasibility.
METHODS: We reviewed 150 patients who underwent zone 2 or more extensive arch replacement using the "Head First" approach from August 2020 to March 2025. Perioperative variables were compared between patients with acute type A aortic dissection (n = 40) and elective repair (n = 84). Logistic regression identified risk factors for stroke.
RESULTS: Patients' median age was 62 [49-69] years, and 64.7% were male. A total of 44% cases were urgent/emergent; 46.7% of patients underwent redo sternotomy, and 77.3% of patients received the frozen elephant trunk procedure. Nadir temperature was 27.4 °C [26 °C-28 °C]. Overall disabling stroke and 30-day mortality were 10.7% and 16.7%, respectively. Compared with elective patients, patients with acute type A aortic dissection had longer bypass (223.5 vs 156 minutes, P < .001) and circulatory arrest (24 vs 16 minutes, P < .001), and more prolonged intubation (65% vs 26.2%, P < .001) and 30-day mortality (40% vs 6%, P < .001). Disabling stroke rates were not significantly different (17.5% vs 8.3%, P = .219), and 3-year cumulative incidence of unplanned reintervention was similar. Male gender was independently protective against stroke (adjusted odds ratio, 0.34, P = .034). In univariable analysis, diabetes was a risk factor for stroke (odds ratio, 3.84, P = .046), whereas age (odds ratio, 1.03, P = .072) and frozen elephant trunk (odds ratio, 7.29, P = .057) showed borderline associations.
CONCLUSIONS: The "Head First" approach demonstrated acceptable outcomes in complex arch replacement. It prioritizes cerebral protection, facilitates timely reconstruction with shorter circulatory arrest, and may improve technical feasibility.