Comparison of Outcome of Total Arch Replacement for Type A Aortic Dissection using Trifurcated Branch Graft vs Island Technique- A Single Centre Experience

Author(s): Kamran Yunus Inamdar, Xu Hua Shan, Wen Bing, Zhao Guochang, Singh Chhatrapratap, Zhao Wen Zeng

Objective

To compare the outcome between trifurcated graft vs island technique for the treatment of type A aortic dissection in a single centre.

Method

From september 2017 to september 2020, we studied 87 patients retrospectively, who underwent total arch replacement for type A aortic dissection. Out of which 51 patients, age (47.45 ± 10.47) years, 39(76.47%) males and 12 (23.52%) females were surgically corrected by trifurcated branch graft technique and 36 patients age (52.75 ± 10.32) years, 27 (75%) males and 9 (25%) females with island technique. In both the groups, peri- operative outcomes were compared. Patients were followed up for 3 months and 6 months in both the groups.

Result

Elective Surgery was done in 16 (31.37%) and 6 (16.66%) in trifurcated branch graft and island group respectively. Selective antegrade cerebral perfusion (SACP) was given by the Axillary artery in {48 (94.11%) in trifurcated group and 3 (8.33%) in island group, p=<.00001}.SACP was given by Innominate artery {5 (9.83%) in trifurcated group and 33 (91.66%) in island group, p=<.00001}. Trifurcated branch group and Island group had Cardiopulmonary Bypass time, cross clamp time, total circulatory arrest time of (245 ± 33.30), (117.62 ± 29.38), (54.33 ± 13.19) min and (195.88 ± 32.83), (70.11 ± 20.62), (33.52 ± 8.683) (p=<.00001); respectively. 30 day mortality was 5(9.83%) in trifurcated group and 3 (8.33%) in island group (p=0.815).

Conclusion

Trifurcated branched graft and island technique, have comparable results, only prerequisite being surgeons comfortability and experience. Trifurcated branch graft being associated with longer CPB, cross clamp and circulatory arrest time, but with no difference in overall adverse outcomes or mortality.