BAO Chunrong , WEI Ke , MEI Ju , ZHANG Yunjiao , ZHANG Li , MA Nan
  • Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P. R. China;
MA Nan, Email: manancts@sina.com
Ascending aortic aneurysm; surgery; aortic arch; deep hypothermic circulatory arrest
10.7507/1007-4848.202206057
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Objective  To summarize the efficacy of aortic arch 1 zone clamping technique in the procedure of ascending aortic aneurysm involving the proximal aortic arch. Methods  The clinical data of patients with ascending aortic aneurysm involving the proximal aortic arch who underwent surgical treatment with aortic arch 1 zone clamping technique in our hospital from 2017 to 2019 were retrospectively analyzed. Results A total of 35 patients were enrolled, including 21 males and 14 females, with an average age of 63.9±10.8 years. According to different lesions, the proximal aorta underwent Bentall/Carbrol procedure in 8 patients, Wheat in 4 patients, David in 3 patients, and ascending aorta replacement in 20 patients. Distal lesions were completely resected under aortic arch 1 zone clamping technique, and anastomotic reconstruction was performed under hypothermic cardiopulmonary bypass. Distal anastomosis was performed with interrupted suture in 7 patients, and continuous suture with intermittent reinforcement of the posterior wall in 28 patients. All patients successfully completed the procedure. The average cardiopulmonary bypass time was 121.5±28.2 min, the aortic clamping time was 78.1±21.3 min, and the distal anastomosis time was 15.2±3.6 min. One patient underwent a second thoracotomy for hemostasis, and the remaining patients were drained 330.6±108.1 mL on the first day following the procedure. The postoperative mechanical ventilation time of 2 patients exceeded 24 hours, and the main complications were pulmonary infection in 1 patient and acute renal injury in 2 patients. Transient delirium occurred in 2 patients and no transient or permanent neurological dysfunction occurred. The average follow-up time was 2.6±1.1 years. The maximum diameter of the ascending aorta after operation was 30.4±0.9 mm, the diameter of zone 1 aortic arch was 39.8±3.1 mm, and the diameter of the distal aortic arch was 32.3±4.3 mm. There was no lesion in the artificial blood vessels of all patients, and no aneurysms occurred at the proximal or distal anastomosis. No reoperation or intervention was needed for the aorta. Conclusion The aortic arch 1 zone clamping technique can simplify the procedure of ascending aortic aneurysm involving the proximal aortic arch, reduce or avoid the use of deep hypothermic circulatory arrest, reduce the surgical trauma, and has good short-term and medium-term efficacy.

Citation： BAO Chunrong, WEI Ke, MEI Ju, ZHANG Yunjiao, ZHANG Li, MA Nan. The efficacy of aortic arch 1 zone clamping technique in the procedure of ascending aortic aneurysm involving the proximal aortic arch. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(11): 1586-1590. doi: 10.7507/1007-4848.202206057 Copy